How depressing, how utterly unjust, to be the one in your social circle who is aging least gracefully.

Jim Wilson/The New York Times

Mike Linksvayer, 36, on a low-calorie diet for six years, is 6 feet and 135 pounds, and his blood pressure is 112 over 63. In a laboratory at the Wisconsin National Primate Research Center, Matthias is learning about time?s caprice the hard way. At 28, getting on for a rhesus monkey, Matthias is losing his hair, lugging a paunch and getting a face full of wrinkles.

Yet in the cage next to his, gleefully hooting at strangers, one of Matthias?s lab mates, Rudy, is the picture of monkey vitality, although he is slightly older. Thin and feisty, Rudy stops grooming his smooth coat just long enough to pirouette toward a proffered piece of fruit.

Tempted with the same treat, Matthias rises wearily and extends a frail hand. ?You can really see the difference,? said Dr. Ricki Colman, an associate scientist at the center who cares for the animals.

What a visitor cannot see may be even more interesting. As a result of a simple lifestyle intervention, Rudy and primates like him seem poised to live very long, very vital lives.

This approach, called calorie restriction, involves eating about 30 percent fewer calories than normal while still getting adequate amounts of vitamins, minerals and other nutrients. Aside from direct genetic manipulation, calorie restriction is the only strategy known to extend life consistently in a variety of animal species.

How this drastic diet affects the body has been the subject of intense research. Recently, the effort has begun to bear fruit, producing a steady stream of studies indicating that the rate of aging is plastic, not fixed, and that it can be manipulated.

In the last year, calorie-restricted diets have been shown in various animals to affect molecular pathways likely to be involved in the progression of Alzheimer?s disease, diabetes, heart disease, Parkinson?s disease and cancer. Earlier this year, researchers studying dietary effects on humans went so far as to claim that calorie restriction may be more effective than exercise at preventing age-related diseases.

Monkeys like Rudy seem to be proving the thesis. Recent tests show that the animals on restricted diets, including Canto and Eeyore, two other rhesus monkeys at the primate research center, are in indisputably better health as they near old age than Matthias and other normally fed lab mates like Owen and Johann. The average lifespan for laboratory monkeys is 27.

The findings cast doubt on long-held scientific and cultural beliefs regarding the inevitability of the body?s decline. They also suggest that other interventions, which include new drugs, may retard aging even if the diet itself should prove ineffective in humans. One leading candidate, a newly synthesized form of resveratrol ? an antioxidant present in large amounts in red wine ? is already being tested in patients. It may eventually be the first of a new class of anti-aging drugs. Extrapolating from recent animal findings, Dr. Richard A. Miller, a pathologist at the University of Michigan, estimated that a pill mimicking the effects of calorie restriction might increase human life span to about 112 healthy years, with the occasional senior living until 140, though some experts view that projection as overly optimistic.

According to a report by the Rand Corporation, such a drug would be among the most cost-effective breakthroughs possible in medicine, providing Americans more healthy years at less expense (an estimated $8,800 a year) than new cancer vaccines or stroke treatments.

?The effects are global, so calorie restriction has the potential to help us identify anti-aging mechanisms throughout the body,? said Richard Weindruch, a gerontologist at the University of Wisconsin who directs research on the monkeys.

Many scientists regard the study of life extension, once just a reliable plotline in science fiction, as a national priority. The number of Americans 65 and older will double in the next 25 years to about 72 million, according to government census data. By then, seniors will account for nearly 20 percent of the population, up from just 12 percent in 2003.

Earlier this year, four prominent gerontologists, among them Dr. Miller, published a paper calling for the government to spend $3 billion annually in pursuit of a modest goal: delaying the onset of age-related diseases by seven years.

Doing so, the authors asserted, would lay the foundation for a healthier and wealthier country, a so-called longevity dividend.

?The demographic wave entering their 60s is enormous, and that is likely to greatly increase the prevalence of diseases like diabetes and heart disease,? said Dr. S. Jay Olshansky, an epidemiologist at the University of Illinois at Chicago, and one of the paper?s authors. ?The simplest way to positively affect them all is to slow down aging.?

Science, of course, is still a long way from doing anything of the sort. Aging is a complicated phenomenon, the intersection of an array of biological processes set in motion by genetics, lifestyle, even evolution itself.

Still, in laboratories around the world, scientists are becoming adept at breeding animal Methuselahs, extraordinarily long lived and healthy worms, fish, mice and flies.

In 1935, Dr. Clive McCay, a nutritionist at Cornell University, discovered that mice that were fed 30 percent fewer calories lived about 40 percent longer than their free-grazing laboratory mates. The dieting mice were also more physically active and far less prone to the diseases of advanced age.

Dr. McCay?s experiment has been successfully duplicated in a variety of species. In almost every instance, the subjects on low-calorie diets have proven to be not just longer lived, but also more resistant to age-related ailments.

?In mice, calorie restriction doesn?t just extend life span,? said Leonard P. Guarente, professor of biology at the Massachusetts Institute of Technology. ?It mitigates many diseases of aging: cancer, cardiovascular disease, neurodegenerative disease. The gain is just enormous.?

Page 2 of 3)

For years, scientists financed by the National Institute on Aging have closely monitored rhesus monkeys on restricted and normal-calorie diets. At the University of Wisconsin, where 50 animals survive from the original group of 76, the differences are just now becoming apparent in the older animals.

Those on normal diets, like Matthias, are beginning to show signs of advancing age similar to those seen in humans. Three of them, for instance, have developed diabetes, and a fourth has died of the disease. Five have died of cancer.

But Rudy and his colleagues on low-calorie meal plans are faring better. None have diabetes, and only three have died of cancer. It is too early to know if they will outlive their lab mates, but the dieters here and at the other labs also have lower blood pressure and lower blood levels of certain dangerous fats, glucose and insulin.

?The preliminary indicators are that we?re looking at a robust life extension in the restricted animals,? Dr. Weindruch said.

Despite widespread scientific enthusiasm, the evidence that calorie restriction works in humans is indirect at best. The practice was popularized in diet books by Dr. Roy Walford, a legendary pathologist at the University of California, Los Angeles, who spent much of the last 30 years of his life following a calorie-restricted regimen. He died of Lou Gehrig?s disease in 2004 at 79.

Largely as a result of his advocacy, several thousand people are now on calorie-restricted diets in the United States, says Brian M. Delaney, president of the Calorie Restriction Society.

Mike Linksvayer, a 36-year-old chief technology officer at a San Francisco nonprofit group, embarked on just such a diet six years ago. On an average day, he eats an apple or some cereal for breakfast, followed by a small vegan dish at lunch. Dinner is whatever his wife has cooked, excluding bread, rice, sugar and whatever else Mr. Linksvayer deems unhealthy (this often includes the entr?e). On weekends, he occasionally fasts.

Mr. Linksvayer, 6 feet tall and 135 pounds, estimated that he gets by on about 2,000 to 2,100 calories a day, a low number for men of his age and activity level, and his blood pressure is a remarkably low 112 over 63. He said he has never been in better health.

?I don?t really get sick,? he said. ?Mostly I do the diet to be healthier, but if it helps me live longer, hey, I?ll take that, too.?

Researchers at Washington University in St. Louis have been tracking the health of small groups of calorie-restricted dieters. Earlier this year, they reported that the dieters had better-functioning hearts and fewer signs of inflammation, which is a precursor to clogged arteries, than similar subjects on regular diets.

In previous studies, people in calorie-restricted groups were shown to have lower levels of LDL, the so-called bad cholesterol, and triglycerides. They also showed higher levels of HDL, the so-called good cholesterol, virtually no arterial blockage and, like Mr. Linksvayer, remarkably low blood pressure.

?Calorie restriction has a powerful, protective effect against diseases associated with aging,? said Dr. John O. Holloszy, a Washington University professor of medicine. ?We don?t know how long each individual will end up living, but they certainly have a longer life expectancy than average.?

Researchers at Louisiana State University reported in April in The Journal of the American Medical Association that patients on an experimental low-calorie diet had lower insulin levels and body temperatures, both possible markers of longevity, and fewer signs of the chromosomal damage typically associated with aging.

These studies and others have led many scientists to believe they have stumbled onto a central determinant of natural life span. Animals on restricted diets seem particularly resistant to environmental stresses like oxidation and heat, perhaps even radiation. ?It is a very deep, very important function,? Dr. Miller said. Experts theorize that limited access to energy alarms the body, so to speak, activating a cascade of biochemical signals that tell each cell to direct energy away from reproductive functions, toward repair and maintenance. The calorie-restricted organism is stronger, according to this hypothesis, because individual cells are more efficiently repairing mutations, using energy, defending themselves and mopping up harmful byproducts like free radicals.

?The stressed cell is really pulling out all the stops? to preserve itself, said Dr. Cynthia Kenyon, a molecular biologist at the University of California, San Francisco. ?This system could have evolved as a way of letting animals take a timeout from reproduction when times are harsh.?

But many experts are unsettled by the prospect, however unlikely, of Americans adopting a draconian diet in hopes of living longer. Even the current epidemiological data, they note, do not consistently show that those who are thinnest live longest. After analyzing decades of national mortality statistics, federal researchers reported last year that exceptional thinness, a logical consequence of calorie restriction, was associated with an increased risk of death. This controversial study did not attempt to assess the number of calories the subjects had been consuming, or the quality of their diets, which may have had an effect on mortality rates.

Page 2 of 3)

For years, scientists financed by the National Institute on Aging have closely monitored rhesus monkeys on restricted and normal-calorie diets. At the University of Wisconsin, where 50 animals survive from the original group of 76, the differences are just now becoming apparent in the older animals.

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Southern Illinois University School of MedicineIn a longevity study at Southern Illinois University the top mouse was fed a calorie-restricted diet, and the one below a normal diet. Both are 28 months old.

MultimediaGraphic Calorie Restriction vs. Normal Diet Readers? OpinionsForum: Fitness and Nutrition Those on normal diets, like Matthias, are beginning to show signs of advancing age similar to those seen in humans. Three of them, for instance, have developed diabetes, and a fourth has died of the disease. Five have died of cancer.

But Rudy and his colleagues on low-calorie meal plans are faring better. None have diabetes, and only three have died of cancer. It is too early to know if they will outlive their lab mates, but the dieters here and at the other labs also have lower blood pressure and lower blood levels of certain dangerous fats, glucose and insulin.

?The preliminary indicators are that we?re looking at a robust life extension in the restricted animals,? Dr. Weindruch said.

Despite widespread scientific enthusiasm, the evidence that calorie restriction works in humans is indirect at best. The practice was popularized in diet books by Dr. Roy Walford, a legendary pathologist at the University of California, Los Angeles, who spent much of the last 30 years of his life following a calorie-restricted regimen. He died of Lou Gehrig?s disease in 2004 at 79.

Largely as a result of his advocacy, several thousand people are now on calorie-restricted diets in the United States, says Brian M. Delaney, president of the Calorie Restriction Society.

Mike Linksvayer, a 36-year-old chief technology officer at a San Francisco nonprofit group, embarked on just such a diet six years ago. On an average day, he eats an apple or some cereal for breakfast, followed by a small vegan dish at lunch. Dinner is whatever his wife has cooked, excluding bread, rice, sugar and whatever else Mr. Linksvayer deems unhealthy (this often includes the entr?e). On weekends, he occasionally fasts.

Mr. Linksvayer, 6 feet tall and 135 pounds, estimated that he gets by on about 2,000 to 2,100 calories a day, a low number for men of his age and activity level, and his blood pressure is a remarkably low 112 over 63. He said he has never been in better health.

?I don?t really get sick,? he said. ?Mostly I do the diet to be healthier, but if it helps me live longer, hey, I?ll take that, too.?

Researchers at Washington University in St. Louis have been tracking the health of small groups of calorie-restricted dieters. Earlier this year, they reported that the dieters had better-functioning hearts and fewer signs of inflammation, which is a precursor to clogged arteries, than similar subjects on regular diets.

In previous studies, people in calorie-restricted groups were shown to have lower levels of LDL, the so-called bad cholesterol, and triglycerides. They also showed higher levels of HDL, the so-called good cholesterol, virtually no arterial blockage and, like Mr. Linksvayer, remarkably low blood pressure.

?Calorie restriction has a powerful, protective effect against diseases associated with aging,? said Dr. John O. Holloszy, a Washington University professor of medicine. ?We don?t know how long each individual will end up living, but they certainly have a longer life expectancy than average.?

Researchers at Louisiana State University reported in April in The Journal of the American Medical Association that patients on an experimental low-calorie diet had lower insulin levels and body temperatures, both possible markers of longevity, and fewer signs of the chromosomal damage typically associated with aging.

These studies and others have led many scientists to believe they have stumbled onto a central determinant of natural life span. Animals on restricted diets seem particularly resistant to environmental stresses like oxidation and heat, perhaps even radiation. ?It is a very deep, very important function,? Dr. Miller said. Experts theorize that limited access to energy alarms the body, so to speak, activating a cascade of biochemical signals that tell each cell to direct energy away from reproductive functions, toward repair and maintenance. The calorie-restricted organism is stronger, according to this hypothesis, because individual cells are more efficiently repairing mutations, using energy, defending themselves and mopping up harmful byproducts like free radicals.

?The stressed cell is really pulling out all the stops? to preserve itself, said Dr. Cynthia Kenyon, a molecular biologist at the University of California, San Francisco. ?This system could have evolved as a way of letting animals take a timeout from reproduction when times are harsh.?

But many experts are unsettled by the prospect, however unlikely, of Americans adopting a draconian diet in hopes of living longer. Even the current epidemiological data, they note, do not consistently show that those who are thinnest live longest. After analyzing decades of national mortality statistics, federal researchers reported last year that exceptional thinness, a logical consequence of calorie restriction, was associated with an increased risk of death. This controversial study did not attempt to assess the number of calories the subjects had been consuming, or the quality of their diets, which may have had an effect on mortality rates.

"Even the current epidemiological data, they note, do not consistently show that those who are thinnest live longest. After analyzing decades of national mortality statistics, federal researchers reported last year that exceptional thinness, a logical consequence of calorie restriction, was associated with an increased risk of death."

I would like to the point that the thinnest might have no muscles, low basal metabolic rate, no exercise. So - why should they live longer? Low calories? - What is low?

I think that low body fat should be the goal - sometimes calories are necessary to keep your muscles well and alive. "On weekends, he occasionally fasts" - which will make him loose muscle mass, as he has no body fat. Even if he had, muscle energy gets lost first.

Calorie restriction alone will not do it. You have to know when and where.

A better number?We obsess over bad cholesterol levels, but when it comes to heart disease risk, good cholesterol may be more important. Next up: New treatments.By Shari RoanTimes Staff Writer

November 6, 2006

FOR the last two decades, a fear of bad cholesterol has gripped Americans. We've measured it, compared it, worried about it and doused it with statins, now among the bestselling drugs of all time.

But hovering on the sidelines has been another type of cholesterol ? HDL, the good kind, also known as high-density lipoprotein. HDL cholesterol doesn't get anywhere near the attention of its bad LDL twin (low-density lipoprotein). But now it may be poised to receive the respect it deserves.

Recent research suggests that HDL may actually be the more important player of the two in raising or lowering heart disease risk. And as the 20th anniversary of the first cholesterol-lowering statin draws close, a new heart disease deterrent is ready to leap onto the stage: the first drug to substantially raise good cholesterol.

If approved, it could usher in a radically new era in the battle against the No. 1 killer of Americans, responsible for 37% of adult deaths in the United States every year.

In fact, by simultaneously tinkering with good and bad ? giving medications in tandem to alter both HDL and LDL ? doctors may finally have the potent one-two punch against heart disease they have long been searching for.

"We've taken LDL management as far as we can go," says Dr. Prediman K. Shah, director of the division of cardiology and the Atherosclerosis Research Center at Cedars-Sinai Medical Center. "Everyone is on the bandwagon that HDL is the next frontier for atherosclerosis management."

Interest in raising HDL cholesterol has been growing in recent years for several reasons. Chiefly, researchers have discovered that HDL prevents or reduces the build-up of plaque in artery walls and appears to be a significant cardiovascular risk factor independent of whether LDL is high or low.

But doctors have long known that LDL cannot be the whole story. Statins, for example, lower LDL cholesterol 30% to 40% and reduce heart attack and stroke rates by about the same amount ? but most doctors can remember patients who dutifully lowered their LDL and still suffered heart attacks or strokes.

"Even with 30% to 40% reduction, we have not eliminated cardiovascular disease," says Dr. William Averill, a cardiologist and past president of the Los Angeles division of the American Heart Assn.

Doctors also know people who have too-high LDL but never succumb to cardiac trouble ? perhaps, in some cases, because their high HDL is protecting them.

The interest in HDL cholesterol is also, to some extent, market-driven. Many drug companies have blockbuster statin drugs with patents that are expiring, and they're searching for ways to reignite the market for treating cardiovascular disease.

In this case, however, market forces and the quest for better heart health may happily align.

When arteries clog

Cholesterol is a type of fat known as a lipid that helps many types of body cells function. The liver manufactures most of what the body needs; the rest is obtained through diet.

The lipid uses a two-way street to travel through the bloodstream: LDL particles are carried from the liver to body cells; HDL particles move in reverse, returning extra cholesterol to the liver for disposal.

When too much LDL is in the blood, it can accumulate along the artery walls, forming the hard plaque deposits that lead to heart attacks. Statins help fight this traffic pileup.

Until the last decade or so, the role of HDL cholesterol in this process was largely overlooked.

"We've had a blind spot about HDL," says Dr. William Tierney, Chancellor's Professor of Medicine at Indiana University School of Medicine and author of a recent study highlighting the importance of HDL levels. "I think that's because we're used to focusing on the bad risk factors. As physicians we think, what can we fix? We fix something that is broken."

But evidence for HDL's benefits has been accumulating in recent years and can no longer be ignored. Animal studies and lab research on cells show that HDL has properties that reduce tissue inflammation and blood clotting and improve blood vessel function.

Additional research has found that the risk of heart disease is lower in people with higher levels of HDL and that tinkering with HDL may give patients more bang for their buck. Studies suggest that reducing LDL by 1 milligram per deciliter cuts cardiovascular risk by 1% ? but raising HDL by 1 mg/dl reduces risk by 2% to 3%.

Tierney's study, published in March in the American Heart Journal, examined 7,000 individuals who had two or more cholesterol measurements between 1985 and 1997. The scientists found that for every 10 mg/dl increase in the HDL level, there was an 11% decrease in heart attacks and other so-called acute coronary events.

In contrast, changes in the subjects' blood LDL levels, or in levels of lipids known as triglycerides (also heart disease risk factors) did not decrease the risk of heart attack or stroke.

"If you believe our research, HDL turns out to be the more important of the two," Tierney says.

Based on the science so far, the National Cholesterol Education Program (a federally funded group that issues guidelines) categorizes people as being at high risk for heart disease if their HDL is less than 40 mg/dl in men and less than 50 mg/dl in women. A level of 60 or higher is considered protective.

About 30% of American adults who have heart disease have sub-optimal HDL as their "dominant abnormality," says Shah ? in other words, low HDL is their most glaring risk factor for heart trouble.

Low HDL is more common in non-hispanic white and Mexican American men than in women or other ethnic groups. But as obesity rates and the incidence of diabetes have risen, HDL levels appear to be declining throughout the population.

Renewed interest in niacin

There are a number of measures that people or doctors can take to ramp up HDL levels. Lifestyle changes, such as a healthful diet and exercise, can boost HDL slightly ? and even small changes can lower heart disease risk (see sidebar). So can statins and drugs called fibrates.

Niacin, also known as vitamin B3, can raise HDL substantially. But there has been a significant problem with this remedy: It can cause intense itching and facial and upper-body flushing.

"Niacin is the most effective HDL drug available. But the problem is that only about 70% of people can take it because of the major side effects," Shah says.

Now, however, Merck & Co. is in the late stages of testing a pill that combines extended-release niacin with a drug called a prostaglandin D2 blocker that prevents flushing. Early studies suggest the drug may raise HDL 20% to 30%, says Dr. Yale Mitchel, executive director for clinical research at Merck.

The company plans to seek permission from the Food and Drug Administration to market the pill, called MK-0524A, next year, Mitchel says.

"I think if [Merck's] strategy proves to be true and effective that would revive interest in niacin," Shah says.

The company is also testing the niacin and prostaglandin D2 blocker in combination with a statin. And it is conducting an international study of 20,000 people to see if MK-0524A reduces cardiovascular events in high-risk people who have already lowered their LDL cholesterol with a statin. This study may be the first to show if raising HDL can truly reduce heart attacks, strokes and deaths even after LDL has been controlled.

"We think this study is critical," Mitchel says. That's because so far, the belief that raising HDL can slash heart disease risk is based on observational studies, ones in which populations of people have simply been observed.

To truly test the idea, a clinical trial is needed in which HDL is raised with drugs (after LDL has already been lowered) and the effect on heart disease is carefully monitored.

That gold-standard clinical trial hasn't been possible before now, Mitchel says, for one principal reason. "We haven't had drugs to raise HDL and test the hypothesis."

Other researchers are focusing on new drugs to improve levels of HDL. One approach evolved after a discovery about 15 years ago of a group of people in Japan who have a genetic mutation that causes high levels of HDL. The people, who have a low incidence of heart disease, lack an enzyme called CETP (cholesteryl ester transfer protein) that is responsible for transferring cholesterol from HDL particles to LDL particles.

Several drug companies are working on oral drugs that block CETP and would thus raise HDL in patients. Torcetrapib, under development at Pfizer Inc., is furthest along. In a small 2004 study of 19 patients with low HDL, torcetrapib raised HDL levels by 46%. It boosted them higher, by 61%, in people receiving torcetrapib plus the statin atorvastatin (Lipitor).

Questions remain about the drug. It may, for one thing, increase blood pressure, Shah says, undermining its benefit to the heart. And even if it raises HDL, that doesn't necessarily mean it will reduce heart disease for certain.

"It may lead to a form of HDL that is dysfunctional. You may get a lot of HDL but it doesn't do anything. That is a concern that has been raised," Shah says.

Heart disease experts are anticipating the results of the company's Phase 3 clinical trials, expected early next year. These will gauge the medicine's effects on heart disease, measuring whether atherosclerotic plaque is reduced.

If the findings are promising, Pfizer could seek approval to sell torcetrapib in combination with Lipitor, its bestselling statin drug, next year or in 2008.

The company recently bowed to public pressure and announced it would also sell torcetrapib alone so that people who don't need a statin (or use statins other than Pfizer's) could benefit from the medication.

Another novel approach to raise HDL ? this one advanced by Shah's studies in animals ? uses high doses of a synthetic type of HDL to diminish plaque buildup. Again, the research stems from observing unusual human beings.

In the 1980s, doctors discovered a small group of people in a picturesque Italian village near Milan who had extraordinarily low levels of HDL but no heart disease. The scientists determined that these people carried a genetic mutation, named ApoA-1 Milano, that gave them a kind of super-charged HDL that is more protective than regular HDL. The gene variant prevents the accumulation of plaque in spite of low HDL levels.

Shah showed that this special HDL could shrink plaque in the arteries of lab animals. That finding was followed by a landmark study published in the Journal of the American Medical Assn. in 2003 that found that five weekly infusions of synthetic ApoA-1 Milano produced a 4.2% decrease in atherosclerotic plaque in people with heart disease.

Several drug companies are working on products based on ApoA-1 Milano. But because it has to be infused into the blood, such a treatment would probably be reserved for people with acute heart disease. "It's not ideally suited for repeat therapy over many years," Shah says.

The discovery of ApoA-1 Milano raises an intriguing question about HDL cholesterol, however. It could be that the quality of HDL is just as important as the quantity, affected by genes or environmental factors that subtly alter its structure and properties. It could be that scientists have just begun to explore the complexities of the good fat that flows through our bloodstreams.

"There is a lot of work going on," Shah says ? work that may uncover new exceptions to any simple test that just measures HDL levels. But for most of us for now, Shah adds, one thing about HDL seems clear: "The more you have, the better off you are."

BOOST YOUR LEVELSIt's more difficult to raise HDL cholesterol than it is to lower LDL. After all, statin drugs alone routinely lower LDL by 30% to 40%. But there are still ways to improve your HDL.Exercise: Aerobic exercise for 30 minutes several times a week can raise HDL by 3% to 9% in sedentary, healthy people. But you'll have to get your heart rate up. There is little evidence that walking increases HDL.Quitting smoking: Average increase of 4 milligrams per deciliter.Weight control: Every 1 kilogram (2.2 pounds) of weight lost raises HDL by average of 0.35 mg/dl. Alcohol consumption: Mild to moderate drinking (one to two drinks a day) can raise HDL by an average of 4 mg/dl.Diet: A diet low in trans fatty acids and high in monounsaturated and polyunsaturated fatty acids can raise HDL. Choose oils such as olive, flaxseed and canola; nuts; cold-water fish; and shellfish. Limit high glycemic load foods such as pasta and bread made with refined flour, which can lower HDL.Niacin therapy: Increases of 20% to 35%.Fibrate therapy: Increases of 10% to 25%.Statins: Increases of 2% to 15%.? Shari RoanSources: American Heart Assn.; Dr. William Averill; New England Journal of Medicine

Something needs to be done in medicine and the entrepreneurs and technologists of the telecosm are the exact people to do it. It involves moving diagnostic medicine into the hands of the consumers?taking the diagnostic and technological tools of medicine and making computer peripherals out of them, as well as making on-person monitors and turning the Internet into an interpretive tool, so that the consumers of medicine can evaluate the product that they receive and medicine itself could be turned into a therapeutic industry competing on the basis of quality and price.

My youngest son Matthew has a dog named Rusty. When Matthew takes Rusty to the veterinarian, the vet can take a blood sample from Rusty, put it in a computer peripheral beside his PC, which costs $1,000, get the analysis in a few minutes, diagnose Rusty, and go on about his business. It measures the same couple of dozen things that would be measured if you went to a physician. Some veterinarians, in fact, send their samples to the local hospital and put them through the same medical devices used for humans.

In any case, the veterinarian can do this for Rusty, but he can?t do this for Matthew. If he measured Matthew?s sample, that would be unlawful. And, if a physician had this device in his office, he also couldn?t use it. That also would be unlawful. The only people allowed to use these devices are working in approved commercial clinical laboratories, and most of those laboratories would not measure a sample if Matthew asked them to do it. But, there is an out. Matthew can measure his own sample. If he does it himself, it is lawful.

Medicine is an odd industry. It is a monopoly that controls not only the product it produces but also the evaluation of its own product. This is a historical result. Initially medicine had very little technology. What was known about medicine resided in the minds of the physicians.

As technology developed for medicine, especially diagnostic technology, this technology involved very expensive machinery and evolved in a time when computers were very expensive. It was just not possible for the people being helped by medicine to handle their own diagnostic work. The industry grew up measuring samples commercially. (It is now about a $100 billion industry.) But, as the monopoly matured, these commercial laboratories disappeared behind the gatekeepers of medicine, so that the individual cannot use high technology or evaluate the product that he is using. Moreover, the technology advances at a slow rate?

The thing that holds back medicine is the quantitative measurement of health. It is necessary to be able to measure quantitatively to make an advance. And yet it is very difficult to do.

Why would you want to do this?

Suppose you could measure the percentage of life remaining to you or at least your physiological age, quantitatively. Things would change. Someone may tell you you?ll live longer if you eat more Vitamin E or exercise or eat your veggies. You can do those things and have the opportunity to go back and re-measure to see if these life style changes have changed your rate of aging either positively or negatively.

The second reason for measuring health quantitatively is the probability of illness. And the third is, if you do get sick, you need to be able to measure your sickness quantitatively.

If you develop cancer and your physician suggests three or four options. What do you do? You pick the one that looks the best and close your eyes and see if you die. It shouldn?t be that way. You should be able to pick a method, watch the rate of growth of the cancer as a function of time, see if it?s improved or made worse by what you are doing, and then modulate and adjust your method of battling the illness?

The greatest amount of information is held in the metabolites, the small molecules found in urine, blood, and saliva that are produced and consumed in the normal course of metabolism. They are where the action is and they are all interlocked in different bio-chemical pathways. You don?t have to measure any specific one. There may be 5,000 of them in there, but if you take a sample of 200, those 200 are carrying information about the other 4,800. For example, 30 percent of the substances in your urine are correlated with your physiological age.

You can obtain tremendous amounts of information by profiling these molecules it is not being done?

The free audio download will take about 28 minutes to hear. The mp3 file is larger than that because the next presentation is on the same mp3. While you are at the site, if you haven't already, be sure to listen to Carver Mead's keynote address (at the end of the agenda).

On Monday, the federal office that oversees the nation's family-planning program got a new boss who doesn't believe in birth control. Eric Keroack is a Massachusetts obstetrician-gynecologist who argues that abstinence until marriage is the only healthy choice for women. Until recently, he served as medical director of a pregnancy-counseling organization that runs down contraception and gives out scientifically false health information?for instance, that condoms "offer virtually no protection" against herpes or HPV. Keroack also promotes a wacky piece of pseudoscience: the claim that premarital sex disrupts brain chemistry so as to create a physiological barrier to happy marriage.

Keroack's appointment, as deputy assistant secretary of population affairs within the Department of Health and Human Services, did not require congressional approval. The Bush administration picked him on its own. And women's health advocates, editorial pages, and bloggers, along with Democratic members of Congress, are right to think he's a crazy choice for this job.

The Title X family-planning program, which Keroack will now oversee, has a federal mandate (http://opa.osophs.dhhs.gov/titlex/ofp.html) to provide information and access to birth control, as well as pregnancy tests and counseling. (Patients may receive referrals for abortion, but Title X funds may not be used to pay for the procedure.) The program also offers information and treatment for sexually transmitted diseases and screening for breast and cervical cancer. Title X has been financially squeezed in recent years, but it still funds approximately 4,500 clinics that serve about 5 million patients across the country.

Keroack's professional history suggests a mismatch, to put it mildly, with Title X's goal of educating women about contraception and helping them get it. He has lectured widely (http://kansascity.abstinence.net/details.php) for groups like the National Abstinence Clearinghouse, which disparages the use of birth control and disseminates medical misinformation. The policy statement of the pregnancy-counseling organization he served as medical director for, A Woman's Concern (http://awomansconcern.com/), says:

A Woman's Concern does not distribute, or encourage the use of, contraceptive drugs and devices. ? A Woman's Concern is persuaded that the crass commercialization and distribution of birth control is demeaning to women, degrading of human sexuality, and adverse to human health and happiness.

Misleading or factually false information about sexual health abounds in the group's educational materials and on its Web site. To disparage the notion of "safe sex" and make the case that abstinence is the only healthy choice, A Woman's Concern teaches (http://awomansconcern.com/rel_safesex.htm) that condoms "only protect against HIV/AIDS 85% of the time, which means you have a 15% chance of contracting it while using a condom." And, lest a patient consider having an abortion, it claims that teens who undergo the procedure "may face an eight times greater risk of contracting breast cancer by age 45."

These claims have been resoundingly discredited. Recent studies show that condom use can substantially reduce the transmission of HPV, herpes, and numerous other STDs. Condoms also dramatically reduce the risk of HIV infection. The research on condoms and HIV transmission that Keroack's group seems to allude to is a report by the National Institutes of Health that found (http://www.hhs.gov/news/press/2001pres/20010720.html) "an 85 percent decrease in risk of HIV transmission" for condom users compared with nonusers (my italics). The twisted version of this statistic touted by A Woman's Concern implies that if 100 kids have sex while using condoms, 15 will become infected with HIV?an absurd suggestion.

As for the purported link between abortion and breast cancer, that old favorite of the pro-life movement was refuted by research published in the New England Journal of Medicine (http://content.nejm.org/cgi/content/short/336/2/81)in 1997. After pro-lifers snuck an ambiguous statement on the topic onto a government Web site in 2002, a scientific panel appointed by the director of the National Cancer Institute knocked it down in 2003. That panel examined all of the available population-based, clinical, and animal data and found no link (http://www.cancer.gov/cancerinfo/ere-workshop-report) between induced abortion and breast cancer. Nor is there a plausible, biological mechanism that would connect abortion to breast cancer. As medical director, Keroack should have known better than to promote this information. That he didn't suggests a willingness to manipulate science to interfere with patients' ability to make informed choices?a willingness to breach the ethics of his profession.

In Keroack's own lectures and writing, he also makes claims designed to scare the bejesus out of kids to convince them to remain abstinent. One pet theory involves the neuropeptide oxytocin, which plays a role in mother-child bonding and social affiliation. Keroack claims that that people who engage in premarital sex experience chronic emotional pain, which lowers their oxytocin levels. This in turn impairs their ability to form healthy relationships down the road. "People who have misused their sexual faculty and become bonded to multiple persons will diminish the power of oxytocin to maintain a permanent bond with an individual," he writes.

Keroack's cites research on oxytocin levels in animals like prairie voles. There are obvious problems in extrapolating from voles to humans, whose brains are much more complex. A handful of human studies show a role for oxytocin in promoting sociability. But there are inconsistencies. One study found that lactating women who had higher plasma levels of oxytocin reported being more sociable. But two others found that women with higher oxytocin levels reported higher relationship distress?precisely the opposite of Keroack's claim. More crucially, there are no data to suggest a causal link between oxytocin levels and marital happiness?or between any of this and premarital sex. Keroack's claim is simply "not borne out by the current evidence," says Jennifer Bartz of Mount Sinai School of Medicine, author of an excellent review article. To be less polite, this is a guy who takes a neuropeptide and a prairie vole and spins from them science fiction.

In his new role, Keroack will have extensive power to shape the kinds of information disseminated to millions of women. He will be able to develop new guidelines for clinics, set priorities, and determine how scarce dollars get spent, says Marilyn Keefe of the National Family Planning and Reproductive Health Association. "We've seen that people in these political slots have a tremendous influence over how programs get implemented," she said. A spokeswoman for the Department of Health and Human Services defended the appointment in an e-mail, stating that "Dr. Keroack is highly qualified and a well-respected physician."

But at a moment when the need for subsidized birth control is rising, and clinics are struggling to pay for basic services?not to mention advances in screening and prevention like the HPV vaccine?a new hire hostile to family planning and accurate medical information is the last thing women need. Keroack has also won props from the Christian right for using ultrasounds in pregnancy counseling. He argues that the images dissuade women from having abortions and that at A Woman's Concern, the number of patients choosing abortions dropped dramatically when the ultrasounds were introduced. So, stay tuned. This innovation, too, may be coming to a publicly funded clinic near you.

The House of Representatives is scheduled to vote on the CentralAmerican Free Trade Agreement in the next two weeks, and onelittle-known provision of the agreement desperately needs to beexposed to public view. CAFTA, like the World Trade Organization, mayserve as a forum for restricting or even banning dietary supplementsin the U.S.

The Codex Alimentarius Commission, organized by the United Nations inthe 1960s, is charged with "harmonizing" food and supplement rulesbetween all nations of the world. Under Codex rules, even basicvitamins and minerals require a doctor's prescription. The EuropeanUnion already has adopted Codex-type regulations, regulations thatwill be in effect across Europe later this year. This raises concernsthat the Europeans will challenge our relatively open market forhealth supplements in a WTO forum. This is hardly far-fetched, asCongress already has cravenly changed our tax laws to comply with aWTO order.

Like WTO, CAFTA increases the possibility that Codex regulations willbe imposed on the American public. Section 6 of CAFTA discusses Codexas a regulatory standard for nations that join the agreement. If CAFTAhas nothing to do with dietary supplements, as CAFTA supporters claim,why in the world does it specifically mention Codex?

Unquestionably there has been a slow but sustained effort to regulatedietary supplements on an international level. WTO and CAFTA are partof this effort. Passage of CAFTA does not mean your supplements willbe outlawed immediately, but it will mean that another internationaltrade body will have a say over whether American supplementregulations meet international standards. And make no mistake aboutit, those international standards are moving steadily toward the Codexregime and its draconian restrictions on health freedom. So thequestion is this: Does CAFTA, with its link to Codex, make it morelikely or less likely that someday you will need a doctor'sprescription to buy even simple supplements like Vitamin C? The answeris clear. CAFTA means less freedom for you, and more control forbureaucrats who do not answer to American voters.

Pharmaceutical companies have spent billions of dollars trying to getWashington to regulate your dietary supplements like Europeangovernments do. So far, that effort has failed in America, in partbecause of a 1994 law called the Dietary Supplement Health andEducation Act. Big Pharma and the medical establishment hate this Act,because it allows consumers some measure of freedom to buy thesupplements they want. Americans like this freedom, however ?especially the health conscious Baby Boomers.

This is why the drug companies support WTO and CAFTA. They seeinternational trade agreements as a way to do an end run aroundAmerican law and restrict supplements through internationalregulations.

The largely government-run health care establishment, including thenominally private pharmaceutical companies, want government to controlthe dietary supplement industry ? so that only they can manufactureand distribute supplements. If that happens, as it already ishappening in Europe, the supplements you now take will be availableonly by prescription and at a much higher cost ? if they are availableat all. This alone is sufficient reason for Congress to oppose theunconstitutional, sovereignty-destroying CAFTA bill.

Also, on its own website, the Codex Alimentarius Commission/FAO states:

================================Objective 6:Promoting Maximum Application of Codex Standards 18. As the pre-eminent international standards setting body for food, the CAC has a clear and strategic interest in promoting the maximum use of its standards both for domestic regulation and international trade. (Emphasis mine.)

If you want to read more, here?s a very comprehensive article with dozens of embedded links:

This article did not make sense to me from a legal perspective (on what authority could Codex take over our laws??), so I did a quick google search. As this is the first I've heard of it, I don't know all the implications or have any informed opinion, but it does seem as though the article you found is in conflict with what's on the fda site, and it seems like a rather large gap of misunderstanding somewhere. http://www.cfsan.fda.gov/~dms/dscodex.html -

We hope the responses below help you understand why the Codex Guidelines for Vitamin and Mineral Food Supplements will not restrict U.S. consumers' access to vitamin and mineral supplements or impose any restrictions that go beyond those established by U.S. law. We also hope the responses help explain why the U.S. participates in the Codex process and how you can keep abreast of Codex activities.

? The Guidelines also include packaging and labeling provisions for vitamin and mineral food supplement products. Would vitamin and mineral supplements sold in the U.S. be required to comply with these?

? If the U.S. is not trying to harmonize its regulatory framework for dietary supplements with Codex, what are the benefits of our country participating in the process of developing these Codex Guidelines?

? How can I keep abreast of the work of Codex?

What has been the U.S. position on these Guidelines?The U.S. supports consumer choice and access to dietary supplements that are safe and labeled in a truthful and non-misleading manner. The Dietary Supplement Health and Education Act of 1994 (DSHEA) ensures that a broad array of dietary supplements are available to U.S. consumers. The Codex Guidelines for Vitamin and Mineral Food Supplements do not, in any way, affect the availability of supplement products to U.S. consumers. On the contrary, the absence of science-based Codex guidelines could adversely affect the ability of U.S. manufacturers to compete in the international marketplace.

Why won't these Guidelines restrict U.S. consumers' access to vitamin and mineral supplements?Some consumers mistakenly believe that with the adoption of the Guidelines on Vitamin and Mineral Food Supplements, the U.S. is required to automatically change its laws and regulations to comply with the international standard. Some have expressed concerns that the World Trade Organization (WTO) and its trade dispute settlement panels may place pressure on the U.S. to change its laws because of international trade agreements such as the Agreement on the Application of Sanitary and Phytosanitary Measures (SPS Agreement), which references Codex as the international organization for food safety standards.

We see no basis for these concerns. First, the DSHEA covers a much broader range of dietary supplements than the vitamin and mineral supplements that are the subject of the Codex Guidelines. Moreover, for supplements covered by these Guidelines, we note the following:

? The SPS Agreement does not require a country to adopt any international standard. Rather, the SPS Agreement provides that members may base their Sanitary and Phytosanitary measures either on international standards, guidelines or recommendations, where they exist, or may establish measures that result in a higher level of protection if there is a scientific justification, or if a country determines it to be appropriate in accord with provisions of the SPS Agreement (SPS Agreement, Article 3(1) and (3)).

? WTO and WTO dispute panels do not have the power to change U.S. law. If a WTO decision in response to a dispute settlement panel is adverse to the U.S., only Congress and the Administration can decide whether to implement the panel recommendation, and, if so, how to implement it.

? For dietary supplements, it is unlikely that another country will accuse the U.S. of imposing a trade barrier for the importation of supplement products into the U.S. marketplace because the U.S. laws and regulations are generally broader in scope and less restrictive than the international standard.

? However, other countries with more restrictive laws and regulations for dietary supplement products than the U.S. may create trade barriers to the importation of products manufactured by the U.S. dietary supplement industry. Thus, the U.S. government's involvement in the setting of international standards can help minimize the potential of trade barriers to U.S products in international trade.

Further, there is no basis for the concern that the Codex Guidelines on Vitamin and Mineral Food Supplements would require dietary supplements be sold as prescription drugs in the United States. First, there is nothing in the Guidelines that suggests that supplements be sold as drugs requiring a prescription. Second, U.S. regulatory agencies are bound by the laws established by Congress, not by Codex standards. Third, because of our generally less restrictive standards, it is unlikely that the trade dispute would be brought against the U.S.

In summary, U.S. consumers' access to a broad array of dietary supplements under DSHEA would not be changed in any way by Codex's adoption of guidelines on vitamin and mineral food supplements.

The Guidelines also include packaging and labeling provisions for vitamin and mineral food supplement products. Would vitamin and mineral supplements sold in the U.S. be required to comply with these?All Codex standards and related texts are voluntary, and vitamin and mineral food supplement products sold in the U.S. would not be required to comply with provisions that are more restrictive than U.S. law (i.e., DSHEA).

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On 11/28/06, > wrote:

I find this essay, from Doug Casey's bi-weekly, WHAT WE NOW KNOW, to be absolutely fascinating. I knew none of this; now, however, I am on alert. I ingest, among other mentioned items, CO-Q 10.

What say those of you who know this matter??

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A Nutricidal CodexBy Shannara Johnson

Ever heard of the Codex Alimentarius? If not, don't be surprised. It's one of the best-kept "open secrets" of the U.S. government. It's scheduled to take effect on December 21, 2009 , and it may present the greatest disaster for our food supply?and thus for our health?this country has ever seen.

What is the Codex Alimentarius, and how did it come to pass?

In the Austro-Hungarian Empire between 1897 and 1911, a collection of standards and regulations for a wide variety of foods was developed, called the Codex Alimentarius Austriacus . It wasn't legally binding but served as a useful reference for the courts to determine standards for specific foods.

The post-World War II rebirth of the Codex Alimentarius (or short, Codex), however, is much more dubious. To understand the full implications, we need to go back to the history of one huge conglomerate: The Interessengemeinschaft Farben, or IG Farben?a powerful cartel that consisted of German chemical and pharmaceutical companies such as BASF, Bayer, and Hoechst.

IG Farben was, you could say, the corporate arm of the Third Reich. Having lucrative contracts with Hitler's regime, IG Farben produced everything from ammunition to Zyklon B, the nerve gas that was used to kill prisoners in the concentration camps. IG Farben was the single largest donor to Hitler's election campaign? and later the single largest profiteer of World War II.

"Whenever the German Wehrmacht conquered another country, IG Farben followed, systematically taking over the industries of those countries," states the website of the Dr. Rath Health Foundation, a non-profit promoter of natural health. "The U.S. government investigation of the factors that led to the Second World War in 1946 came to the conclusion that without IG Farben the Second World War would simply not have been possible."

Auschwitz, the largest and most infamous German concentration camp, also benefited IG Farben. New, unsafe pharmaceutical drugs and vaccines were liberally tested on Auschwitz prisoners?many of which died during the tests.

Not surprising, the Nuremberg War Crime Tribunal prosecuted 24 IG Farben board members and executives for mass murder, slavery and other crimes against humanity. One of those convicted was Fritz ter Meer, the highest-ranking scientist on the executive board of IG Farben, who was sentenced to seven years in prison (of which he only served four). When asked during trial whether he thought those human experiments had been justified, he answered that "concentration camp prisoners were not subjected to exceptional suffering, because they would have been killed anyway."

In 1955, ter Meer was reinstated as a member of the supervisory board at Bayer and one year later became its chairman. In 1962, together with other executives of BASF, Bayer and Hoechst, he was one of the main architects of the Codex Alimentarius.

"When he got out of jail, he went to his UN buddies," said Dr. Rima Laibow, MD, in a passionate speech at the 2005 conference of the National Association of Nutrition Professionals (NANP). "And he said, '[?] If we take over food worldwide, we have power worldwide.'"

The result was the creation of a trade commission called the Codex Alimentarius Commission, now funded and run by the UN's World Health Organization (WHO) and the Food and Agricultural Organization (FAO).

At its foundation in 1994, the World Trade Organization (WTO) accepted the standards of the Codex?and by the end of 2009, all member countries of the WTO will be required to implement the Codex, "to harmonize the standards" for the global trade of foods.

In the U.S. meanwhile, Congress passed the Dietary Supplements Health and Education Act (DSHEA) in 1994, which defined vitamins, minerals and herbs as foods, therefore not to be regulated by pharmaceutical standards. The Codex Alimentarius would reverse all that. It would treat those dietary supplements not as foods, but as toxins.

"How do you protect somebody from a poison?" asks Laibow. "You use toxicology. You use a science called 'risk assessment.'"

Risk assessment, she explains, works as follows. You take the toxin in question, feed it to lab animals and "determine the dose that kills 50% of them. That's called the LD 50. And you extrapolate what the LD 50 for a human being might be. Then you go down to the other end of the dosage range and you start feeding [little] bits of it to test animals, and you come up with the largest possible dose?the maximum permissible upper limit?that can be fed to an animal before a discernible impact is shown. [?] Then you divide that by 100. [?] And now you've got a safety margin, so you got 1/100 of the largest dose that can be given with no discernible impact."

In other words, classified as toxins, vitamins, minerals and herbs would only be allowed to be marketed in doses that have no discernible impact on anyone. Then why bother taking them?

And that's not all. Where our grocery and health food store shelves are now brimming with supplements, only 18 of them would be on the Codex whitelist. Everything not on the list, such as CoQ10, glucosamine, etc. would be illegal?not as in "prescription-only" illegal, but as in "take it and you go to jail" illegal.

But the mandatory requirements of the Codex will not only concern vitamins and minerals, but all foods. Under Codex rules, nearly all foods must be irradiated. And levels of radiation can be much higher than previously permitted.

While irradiated U.S. foods are currently treated with 1 ? 7.5 kiloGray of radiation, the Codex would lift its already high limit of 10kiloGray?the equivalent of ca. 330 million chest X-rays?"when necessary to achieve a legitimate technological purpose," whatever that may be. Granted, the text says, that the dose of radiation "should not compromise consumer safety or wholesomeness of the food." Note, however, that it says "should," not "shall" (an important legal difference, since "should" is not compulsory).

You buy rBST-free milk? Not much longer, because under the Codex all dairy cows will have to be treated with Monsanto's recombinant bovine growth hormone. All animals used for human consumption will have to be fed antibiotics. Organic standards will be relaxed to include such measures. And did we mention that under the Codex, genetically modified (GM) produce will no longer have to be labeled?

Say good-bye to true organic food, and maybe even food that retains any resemblance of nutritional value.

Moreover, in 2001, twelve hazardous, cancer-causing organic chemicals called POPs (Persistent Organic Pollutants) were unanimously banned by 176 countries, including the United States. Codex Alimentarius will bring back seven of these forbidden substances?such as hexachlorobenzene, dieldrin, and aldrin?to be freely used again. Permitted levels of various chemicals in foods will be upped as well.

What, are they trying to kill us?

Rima Laibow has done the math, she claims, using figures coming directly from the WHO and FAO. And according to those epidemiological projections, she believes that just the Vitamin and Mineral Guideline alone will result in about 3 billion deaths. "1 billion through simple starvation," she says. "But the next 2 billion, they will die from the preventable diseases of under-nutrition."

She calls the new Codex standards "food regulations that are in fact the legalization of mandated toxicity and under-nutrition."

Even if you're thinking of emigrating to Thailand or Guatemala to escape this nutritional holocaust, forget it. Once implemented, the Codex Alimentarius will set food safety standards, rules and regulations for over 160 countries, or 97% of the world's population.

The only way is to fight it before it gets implemented, says Laibow, who is working on just that with a team of lawyers. If you want to help, send an email to your Congressman and/or sign the citizens petition on Laibow's website, www.HealthFreedomUSA.org.

Functional medicine is a science-based field of health care that is grounded in the following principles:

Biochemical individuality describes the importance of individual variations in metabolic function that derive from genetic and environmental differences among individuals. Patient-centered medicine emphasizes "patient care" rather than "disease care," following Sir William Osler’s admonition that "It is more important to know what patient has the disease than to know what disease the patient has." Dynamic balance of internal and external factors. Web-like interconnections of physiological factors – an abundance of research now supports the view that the human body functions as an orchestrated network of interconnected systems, rather than individual systems functioning autonomously and without effect on each other. For example, we now know that immunological dysfunctions can promote cardiovascular disease, that dietary imbalances can cause hormonal disturbances, and that environmental exposures can precipitate neurologic syndromes such as Parkinson’s disease. Health as a positive vitality – not merely the absence of disease. Promotion of organ reserve as the means to enhance health span. Functional medicine is anchored by an examination of the core clinical imbalances that underlie various disease conditions. Those imbalances arise as environmental inputs such as diet, nutrients (including air and water), exercise, and trauma are processed by one’s body, mind, and spirit through a unique set of genetic predispositions, attitudes, and beliefs. The fundamental physiological processes include communication, both outside and inside the cell; bioenergetics, or the transformation of food into energy; replication, repair, and maintenance of structural integrity, from the cellular to the whole body level; elimination of waste; protection and defense; and transport and circulation. The core clinical imbalances that arise from malfunctions within this complex system include:

Hormonal and neurotransmitter imbalances Oxidation-reduction imbalances and mitochondropathy Detoxification and biotransformational imbalances Immune imbalances Inflammatory imbalances Digestive, absorptive, and microbiological imbalances Structural imbalances from cellular membrane function to the musculoskeletal system Imbalances such as these are the precursors to the signs and symptoms by which we detect and label (diagnose) organ system disease. Improving balance – in the patient’s environmental inputs and in the body’s fundamental physiological processes – is the precursor to restoring health and it involves much more than treating the symptoms. Functional medicine is dedicated to improving the management of complex, chronic disease by intervening at multiple levels to address these core clinical imbalances and to restore each patient’s functionality and health. Functional medicine is not a unique and separate body of knowledge. It is grounded in scientific principles and information widely available in medicine today, combining research from various disciplines into highly detailed yet clinically relevant models of disease pathogenesis and effective clinical management.

Functional medicine emphasizes a definable and teachable process of integrating multiple knowledge bases within a pragmatic intellectual matrix that focuses on functionality at many levels, rather than a single treatment for a single diagnosis. Functional medicine uses the patient’s story as a key tool for integrating diagnosis, signs and symptoms, and evidence of clinical imbalances into a comprehensive approach to improve both the patient’s environmental inputs and his or her physiological function. It is a clinician’s discipline, and it directly addresses the need to transform the practice of primary care.

Heather Bancroft/George Washington UniversityWith him is Dr. Frederick C. Lough, director of cardiac surgery at George Washington University Hospital and himself a runner. But near the start of the Marine Corps Marathon on Oct. 29, Mr. Turner raised an arm to wave at bystanders, and “everything went black.” Collapsing violently, he gashed his head, chipped a tooth and bit a deep hole in his bottom lip.

Mr. Turner, who had passed a stress test a year before, had just had a heart attack.

This has been an unusual season for the cardiac health of marathoners. After years in which almost no deaths were attributed to heart attacks at this country’s major marathons, at least six runners have died in 2006.

Two police officers, one 53, the other 60, died of heart attacks at the Los Angeles Marathon in March. The hearts of three runners in their early 40s gave out during marathons in Chicago in October, San Francisco in July and the Twin Cities in October. And at the same marathon where Mr. Turner was felled, another man, 56, crumpled near the 17th mile, never to recover.

This year’s toll has sobered race directors and medical directors of marathons. But, as Rick Nealis, the director of the Marine Corps Marathon, said, “Statistically, maybe, it was inevitable.”

Race fields have grown. In 2005, 382,000 people completed a marathon in the United States, an increase of more than 80,000 since 2000, according to marathonguide.com. Meanwhile, the risk of dying from a heart attack during a marathon is about 1 in 50,000 runners, said Dr. Arthur Siegel, the director of internal medicine at McLean Hospital in Belmont, Mass., and an assistant professor of medicine at Harvard.

But some physicians, including Dr. Siegel, an author of more than two dozen studies of racers at the Boston Marathon, wonder if there is more to the deaths than mathematical inevitability: Does racing 26.2 miles put a heart at risk?

A new study by Dr. Siegel and colleagues at Massachusetts General Hospital and other institutions is at least suggestive. Sixty entrants from the 2004 and 2005 Boston Marathon were tested before and after the race. Each was given an echocardiogram to find abnormalities in heart rhythm and was checked for blood markers of cardiac problems — in particular for troponin, a protein found in cardiac muscle cells. If the heart is traumatized, troponin can show up in the blood. Its presence can determine whether there has been damage from a heart attack.

The runners (41 men, 19 women) had normal cardiac function before the marathon, with no signs of troponin in their blood. Twenty minutes after finishing, 60 percent of the group had elevated troponin levels, and 40 percent had levels high enough to indicate the destruction of heart muscle cells. Most also had noticeable changes in heart rhythms. Those who had run less than 35 miles a week leading up to the race had the highest troponin levels and the most pronounced changes in heart rhythm.

The findings, published in the Nov. 28 issue of Circulation, a journal of the American Heart Association, were a surprise, and not least to the runners. None had reported chest pains or shortness of breath at the finish. All had felt fine, Dr. Siegel said (to the extent one can feel fine after pounding through 26.2 miles).

Within days, the abnormalities disappeared. But something seemed to have happened in the race. “Their hearts appeared to have been stunned,” Dr. Siegel said.

“Although the evidence is not conclusive, it does look like the Boston study is showing some effect on cardiac muscle,” said Dr. Paul D. Thompson, 59, the director of cardiology at Hartford Hospital in Connecticut, and an author of an editorial that accompanied the study. “It’s far too early to draw any conclusions,” he added. “We’d be seeing lots more bodies piling up if there were real lingering long-term cardiac damage” caused by running marathons.

“Over all, the evidence is strongly in favor of the idea that endurance exercise is helpful in terms of cardiac health,” said Dr. Thompson, who has run more than 30 marathons.

But questions do remain. Another new study, this one out of the University of Duisburg-Essen in Germany, showed completely unexpected results in a group of experienced middle-aged male marathoners. In the study, which was presented in November at a meeting of the American Heart Association, the subjects, each of whom had completed at least five marathons, underwent an advanced type of heart screening called a spiral CT scan. Unlike echocardiograms or stress tests, spiral CTs show the level of calcium plaque buildup or atherosclerosis in the arteries.

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Is Marathoning Too Much of a Good Thing for Your Heart? E-MailPrint Single Page Reprints Save

Published: December 7, 2006(Page 2 of 2)

More than a third of the runners had significant calcium deposits, suggesting they were at relatively high risk for a heart attack. Only 22 percent of a control group of nonrunners had a comparable buildup.

The researchers scrupulously avoided suggesting that marathoning had caused the men to develop heart disease. (After all, running may have kept them alive when they would otherwise have keeled over years earlier.) But neither did the authors rule out the possibility that in some baffling way distance running had contributed to the men’s arterial gunk.

What worries Dr. Siegel and some of his colleagues is that marathons present an opportunity for silent symptomless heart disease to introduce itself abruptly. The pulsing excitement, the adrenaline, the unpleasant process of “hitting the wall” may trigger physiological changes that loosen arterial plaques, precipitating a heart attack, Dr. Siegel said.

His advice to runners with any history of heart trouble is “train for the race, getting the cardiac benefits of endurance exercise,” then watch the event on television.

The risk of going into cardiac arrest as a spectator, he said, is only about one in a million. (The applicable studies of spectators involved Super Bowl fans.)

Anyone considering joining the ranks of marathoners should undergo a full medical screening, with a visit to a cardiologist for those over 40, Dr. Siegel said. Spiral CT scans are desirable (the cost can range from $250 to $850) and are covered by insurance if recommended by a physician.

Those with a family history of cardiac problems should be especially cautious. “You can’t outrun your genes,” Dr. Siegel said, a reality that marathon medical experts call the Jim Fixx effect, after the author of “The Complete Book of Running,” who died of a heart attack in 1984 at 52. His father had also died young.

Still, the majority of cardiologists remain avid fans of marathons. “It is an extraordinary event,” said Dr. Frederick C. Lough, the director of cardiac surgery at George Washington University Hospital in Washington. “But you have to respect that distance. It’s not something everyone necessarily should attempt.”

Dr. Lough, 57, was less than a block behind Mr. Turner when the older man collapsed. He interrupted his own race to help revive Mr. Turner and accompany him to the hospital, before completing the marathon. “It was a vivid reminder that running does not make anyone immune to heart disease,” Dr. Lough said.

Experts familiar with the new cardiac studies of marathoners urge caution and perspective. The numbers of people studied were small, the findings unexplained, and results have not yet been replicated.

Don’t use the studies, in other words, to justify parking yourself smugly on the couch. “There’s not yet in my opinion cause for alarm,” Dr. Thompson said. “I would still tell people, run.”

His words doubtless will cheer Mr. Turner. “You know the worst thing about almost dying?” he said. “That I didn’t finish.” After having had a stent installed in his heart to open an artery that was about 98 percent blocked, he’s now walking a mile a day and planning his comeback. “I want to get that 10th marathon in,” he said.

But not before he gets a full medical screening, including a spiral CT scan.

Here is a Holiday tip.Oil-- Olive oil that is-- Not just 8 days a week; but 365 days a year!

New Year's Resolution No. 1: Prevent Cancer, Use Olive OilIf you want to avoid developing cancer, then you might want to add eating more olive oil to your list of New Year's resolutions. In a study to be published in the January 2007 issue of The FASEB Journal, scientists from five European countries describe how the anti-cancer effects of olive oil may account for the significant difference in cancer rates among Northern and Southern Europeans.

The authors drew this conclusion based on the outcomes of volunteers from Denmark, Finland, Germany, Italy, and Spain, who consumed 25 milliliters (a little less than a quarter cup) of olive oil every day for three weeks. During this time, the researchers examined urine samples of the subjects for specific compounds known to be waste by-products of oxidative damage to cells, a precursor to cancer. At the beginning of the trial, the presence of these waste by-products was much higher in Northern European subjects than their Southern European counterparts. By the end of three weeks, however, the presence of this compound in Northern European subjects was substantially reduced.

"Determining the health benefits of any particular food is challenging because of it involves relatively large numbers of people over significant periods of time," said lead investigator Henrik E. Poulsen, M.D. of Rigshospitalet, Denmark. "In our study, we overcame these challenges by measuring how olive oil affected the oxidation of our genes, which is closely linked to development of disease. This approach allows us to determine if olive oil or any other food makes a difference. Our findings must be confirmed, but every piece of evidence so far points to olive oil being a healthy food. By the way, it also tastes great."

Another interesting finding in the study suggests that researchers are just beginning to unlock the mysteries of this ancient "health food." Specifically, the researchers found evidence that the phenols in olive oil are not the only compounds that reduced oxidative damage. Phenols are known antioxidant compounds that are present in a wide range of everyday foods, such as dark chocolate, red wine, tea, fruits, and vegetables. Despite reducing the level of phenols in the olive oil, the study's subjects still showed that they were receiving the same level of health benefits.

"Every New Year people make resolutions that involve eating less fat to improve their health," said Gerald Weissmann, MD, Editor-in-Chief of The FASEB Journal. "This academically sound, practically useful study shows that what you eat is just as important as how much you eat. No wonder Plato taught wisdom in an olive grove called Academe."

The FASEB Journal (http://www.fasebj.org) is published by the Federation of American Societies for Experimental Biology (FASEB) and is consistently ranked among the top three biology journals worldwide by the Institute for Scientific Information. FASEB comprises 21 nonprofit societies with more than 80,000 members, making it the largest coalition of biomedical research associations in the United States. FASEB's mission is to enhance the ability of biomedical and life scientists to improve -- through their research -- the health, well-being, and productivity of all people. FASEB serves the interests of these scientists in those areas related to public policy, facilitates coalition activities among member societies, and disseminates information on biological research through scientific conferences and publications.

http://ezraklein.typepad.com/blog/2006/12/the_healthy_ame.htmlThe Healthy Americans ActIt's been some time since I've run across a genuinely new health care proposal, but the comprehensive reform legislation Ron Wyden's unveiled today is just such a beast. Wyden, a gangly goofball of a Senator who last turned heads for his tax reform ideas, must have decided fully restructuring the tax code was thinking too small, so this morning, he took over the Senate Finance Committee's hearing room, brought in an array of union leaders, CEOs, and health wonks, and argued to totally scrap the employer-based health system.

Here's how it would work: The Healthy Americans Act of 2007 would begin by dissolving all employer-based insurance. Instead, it would mandate that every employer who had covered his employees in 2006 convert the total they spent on insurance into salary increases creating, in one day, the single largest pay raise America has ever seen. Now, why would employers go along with that? Well, legislatively they'd have to, but, as Len Nichols explained to me, they'll also want to: Health costs are accelerating, every year costs 10 or so percent more than they ear before. By freezing the total at what employers paid in 2006, Wyden's plan would exempt them from 2007's increase.

Meanwhile, an individual mandate would be implemented, forcing every American to purchase one of the options offered by their state's newly formed Health Help Agency (HHA). The HHA's will have a menu of private insurance plans, all of which must provide coverage equal to or better than the Blue Cross Blue Shield Standard Plan used by Congress. All plans will be community rated by the state, meaning an end to adverse selection and preexisting condition problems. The only acceptable variables for price will be geography, family size, and smoking status. Subsidies will be offered up to 400 percent of the poverty line, will full coverage provided to those below 100 percent. Employers will contribute through a set equation related to business size and yearly profits. There's quite a bit more, but that's the basic outline.

I have to spend some more time with the legislation ("c'mon baby, open up to me, tell me your secrets..."), but my snap reaction is heavily favorable. It isn't everything I'd want, but imposing the combination of community rating and an insurance floor will be a huge step forward. The cost stability offered to employers seems very, very savvy, as does the forced conversion of 2006 health costs into salary increases. The Lewin Group, the gold standard in health care actuarial data (I can't believe I just wrote that sentence), has evaluated the plan. Their conclusion? The plan would cover more than 99 percent of Americans, we'd save $4.8 billion in the first year and $1.48 trillion over the next decade. How's that sound? To me, it sounds like precisely the sort of big thinking Democrats need to be doing now that they're back in the majority.

DIABETES BREAKTHROUGH; TORONTO SCIENTISTS CURE DISEASE IN MICE: In a discovery that has stunned even those behind it, scientists at a Toronto hospital say they have proof the body's nervous system helps trigger diabetes, opening the door to a potential near-cure of the disease that affects millions of Canadians. Diabetic mice became healthy virtually overnight after researchers injected a substance to counteract the effect of malfunctioning pain neurons in the pancreas."I couldn't believe it," said Dr. Michael Salter, a pain expert at the Hospital for Sick Children and one of the scientists. "Mice with diabetes suddenly didn't have diabetes any more."

The recent E. coli outbreaks are playing as a familiar morality tale of too little regulation. The real story is a much bigger scandal: How special interests have blocked approval of a technology that could sanitize fruits and vegetables and reduce food poisoning in America.

The technology is known as food "irradiation," a process that propels gamma rays into meat, poultry and produce in order to kill most insects and bacteria. It is similar to milk pasteurization, and it's a shame some food marketer didn't call it that from the beginning because its safety and health benefits are well established. The American Medical Association, the Centers for Disease Control (CDC), the Food and Drug Administration and the World Health Organization have all certified that a big reduction in disease could result from irradiating foods.

Says Michael Osterholm, director of the Center for Infectious Disease Research at the University of Minnesota: "If even 50% of meat and poultry consumed in the United States were irradiated, the potential impact on foodborne disease would be a reduction in 900,000 cases, and 350 deaths." A 2005 CDC assessment agrees: "Food irradiation is a logical next step to reducing the burden of food borne diseases in the United States."

We asked several leading health scientists whether food irradiation could have prevented the E. coli outbreak at Taco Bell restaurants. "Almost certainly, yes," says Dennis Olson, who runs a research programs on food irradiation at Iowa State University. A recent study by the USDA's Agriculture Research Service confirms that "most of the fresh-cut (minimally processed) fruits and vegetables can tolerate a radiation of 1.0 kGy, a dose that potentially inactivates 99.999% of E. coli."

So what's stopping irradiation? The answer is a combination of political pressure, media scare tactics and bureaucratic and industry timidity. And it starts with organic food groups and such left-wing pressure groups as Public Citizen that have engaged in a fright campaign to persuade Americans that irradiation causes cancer and disease. Something called the Stop Food Irradiation Project tells consumers to tell grocers not to carry irradiated foods.

The liberal-leaning Consumer Reports gave credence to these claims in a 2003 article suggesting that the chemicals formed in meat as a result of irradiation may cause cancer. Public Citizen President Joan Claybrook has served on the Consumer Reports board. Eric Schlosser, author of the best-selling "Fast Food Nation," also disparages irradiation as an "exotic technology" developed "while conducting research for the Star Wars antimissile program." Scary.

None of these mythologies has ever been substantiated by science. The Centers for Disease Control concluded its investigation by noting: "An overwhelming body of scientific evidence demonstrates that irradiation does not harm the nutritional value of food, nor does it make the food unsafe to eat." According to Paisan Loaharanu, a former director at the Food and Agriculture Organization of the United Nations, "The safety of irradiated foods is well established through many toxicological studies. . . . No other food technology has gone through more safety tests than food irradiation."

The Food and Drug Administration bears some of the blame for bending to political pressure and slowing the spread of food irradiation. The food processing industry requested permission to apply irradiation to enhance the safety of produce in 1999, but seven years later the agency still hasn't approved this "food additive." The FDA does allow irradiation for meat, but it requires warning labels that send a message to consumers that eating such beef or chicken is risky. Elizabeth Whelan of the American Council on Science and Health points out that the FDA would be wiser to require that meats and produce that aren't irradiated have a safety warning label. Those are the potentially unsafe foods.

Somehow this side of the story never seems to make it into the mainstream media. Instead, the press replays the familiar yarn that the E. coli outbreaks are caused by budget cuts and government collusion with industry. In fact, FDA spending on food safety has increased to $535 million in 2006 from $354 million in 2001, a 51% increase. (See nearby chart.) In any case, such inspections and more regulations can never hope to prevent E. coli as well as irradiation does. The government couldn't possibly hire enough inspectors to track the many sources of fresh produce in the U.S.

Over the past 50 years, the U.S. has reduced by roughly half the death and illness from foodborne disease. Yet 325,000 Americans are still hospitalized and 5,000 die each year from contaminated food. Today only about 1% of our meat and produce is irradiated, though the technology was invented here. Such nations as India, Mexico and Thailand are starting to irradiate most of the food they export to the U.S., which means that produce from abroad could be safer than that grown here. The real scandal of these E. coli outbreaks is that public safety has taken a back seat to political correctness and bureaucratic delay at the FDA.

By GINA KOLATAPublished: December 26, 2006When researchers reported recently that a precipitous drop in breast cancer rates might be explained by a corresponding decrease in the use of hormones for menopause, women reacted with shock, anger and, in some cases, profound relief that they had never taken the drugs.

RelatedComplete Coverage: HormonesBut many also had questions. How certain were scientists that the hormones were responsible? How could stopping hormones have such an immediate and pronounced effect? And how much did scientists really know about the biology of breast cancer and hormones?

The data seemed clear enough. In 2003, after climbing for almost seven decades, the breast cancer rate fell for the first time in the United States, and it fell sharply. Over all, the incidence of newly diagnosed breast cancer dropped 7 percent, and it dropped 15 percent among women with cancers whose growth is fueled by estrogen.

There also was no question that at the same time, women had begun to abandon hormones as a treatment for menopause. In July 2002, a large study, the Women's Health Initiative, concluded that a popular hormone therapy for menopause, Prempro, made by Wyeth, slightly increased the risk of breast cancer. Within the next six months, prescriptions for Prempro dropped by half.

A connection between hormone use and breast cancer rates did not surprise scientists like Dr. V. Craig Jordan, vice president and scientific director for the medical science division at Fox Chase Cancer Center in Philadelphia. Dr. Jordan is a leader in studying the effects of estrogen-blocking drugs on breast cancer. Among his many awards is this year's American Cancer Society Award from the American Society for Clinical Oncology for his work on estrogen and the prevention and treatment of breast cancer.

Dr. Jordan's wife, Dr. Monica Morrow, a breast cancer surgeon, is chairwoman of the surgical oncology department at Fox Chase. Their offices, he says, are across the hall from each other, "so we are together 24 hours a day."

Q. Prempro, the combination drug that many women took for menopause symptoms, contains both estrogen and progestins. And the findings from the Women's Health Initiative study suggested that estrogen alone has only a tiny effect, if any, on breast cancer risk. So which is the bad actor, progestins or estrogen? Or is it both hormones combined?

A. We've known for 30 years that estrogen can directly cause the growth of breast cells and of endometrial cells. Estrogen is fuel for the fire. But progesterone seems to do different things in different places in a woman's body. In the uterus, it stops the growth of the endometrium and makes it ready for implanting a fertilized egg. In breast cancer, estrogen causes a doubling of cancer cells every 36 hours. Soon, the growing tumor ball needs to increase its blood supply because cells in the middle are not getting enough food and oxygen. Progesterone seems to cause other cells, stromal cells, to gather around the ball of cancer cells and play a supporting role. Stromal cells are the woman's own cells that researchers now think may be specifically selected to build an architecture and send out signals for more blood supply, more fuel.

Q. That seems to be an unusual arrangement. Why would progesterone act on stromal cells in the breast?

A. When a woman is pregnant, her breasts are much larger and her estrogen and progesterone levels are huge. Progesterone is sending out signals that provide a skeleton to build the breasts.

Q. Was it a surprise to learn that estrogen and progestins can cause breast cancer?

A. We've known there is a cause and effect with hormones and breast cancer since 1896. If a woman is premenopausal and she has breast cancer and you take out her ovaries, the tumors decrease in size. Not all the tumors - if you took 100 women who were premenopausal and took their ovaries out, 35 percent would have a response. And you could get a dramatic response. A tumor that was the size of a walnut could shrink in six months to the size of a pinhead. It turned out that the tumors that responded contained estrogen receptors. This became cause and effect - the estrogen receptor was the mechanism that estrogen used to stimulate tumors to grow. If there was no estrogen receptor, taking away estrogen didn't do anything at all.

A. This is the basic difficulty. We were dealing with advanced breast cancer, and what we saw was that we could get complete remissions in 4 or 5 percent of the women. In the majority of women, the remission would last for one to two years. Taking away estrogen slowed things down, it reversed the process, but it did not cure.

Q. Do you agree with the latest analysis indicating that breast cancer is declining because so many women stopped taking Prempro and other menopausal hormones?

A. Throughout the 1990s, physicians were recommending that menopausal women take hormone replacement therapy. What happens is that you increased the rate of breast cancer in the whole country. And it shifted the epidemiology. We have seen an increase in the percentage of estrogen-receptor-positive tumors in the 1990s and in the beginning of the 2000s, so that now 70 percent of tumors are estrogen-receptor positive.

This was, if you like, consistent. Everything was ticking in. The Women's Health Initiative and the Million Women Study in Britain really said: "Here's a controlled series of studies comparing taking nothing with taking hormone replacement therapy. How many cancers were there at the end of the day?"

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The Women's Health Initiative found a 23 percent increase in breast cancer; the Million Women Study found a 100 percent increase. Those studies were highly publicized and women stopped taking hormones. Now the breast cancer rates are going down. Now tumors you would have detected are not being detected. There is no proof the tumors will ever go away, but you can't detect them. And it is possible that many subclinical cancer cells may never grow inside a woman's breast if she has no estrogen around to fuel that fire.

Skip to next paragraphRelatedComplete Coverage: HormonesQ. If a woman has a tumor that is undetectable because she did not take menopausal hormones, will it eventually grow anyway and turn into a cancer that can be seen on a mammogram?

A. We don't know. What we have learned from the tamoxifen clinical trial is that tamoxifen, which blocks estrogen, did a fantastic job. The cancer rate in the group taking tamoxifen dropped by 50 percent. Tamoxifen prevented the development of breast cancers that were early stage, and it also stopped cells from progressing to breast cancer.

Q. Some people suggest that the real problem was that the hormones women were taking were artificial or were given in artificial ways. Prempro, for example, gets its estrogen from pregnant mares. Some say other hormone preparations, for example, so-called bioidentical hormones, would be safe. Do you agree?

A. We've been talking about women's ovaries producing estrogen and progesterone. When a woman enters menopause, hormone levels drop dramatically. The longer you bathe a woman's breasts in these hormones, the more likely she will have cancer. If you start menstruating early, if you have two extra years of estrogen in your body, bathing your breasts in that fuel is a risk factor for breast cancer. If you start menopause late, if your periods go on for an extra four or five years, that is a risk. The longer you have menstrual cycles, the higher your probability of breast cancer. And that is with natural hormones, the ones in your body.

Q. What about birth control pills? Do they increase the risk of breast cancer?

A. We have had testing of birth control pills in huge groups of women since the 1950s, and there really is no evidence of a significant rise in breast cancer risk. What we do know is that oral contraceptives reproduce the messages in the brain to stop a woman from ovulating. You are bathing a woman's body with artificial hormones, but normally she would be bathing her own body with estrogen and progesterone. You don't have women getting endometrial cancer, and oral contraceptives reduce the risk of getting ovarian cancer by 50 percent. It is one of the few things we know of that reduces the risk of ovarian cancer.

Q. What about chemicals in the environment, like DDT or chemicals in plastics, that can mimic estrogen. Could they be causing breast cancer?

A. There are a group of compounds like DDT that are byproducts of industry and are in our environment. They can affect cells in the laboratory and can affect the reproduction of animals, but in really huge doses. There is an effect, but does it cause an increase in cancer? I personally don't believe that is the case. I don't think there is enough around to do that. A pinch of estrogen in the environment is very small compared to the gallons in a woman's body.

Q. What should women do now? Should they ever take menopausal hormones?

A. The value of hormone therapy for women with extremely severe menopausal symptoms is well established, and women, in consultation with their doctors, should consider using it for only a few months to alleviate severe symptoms. The main concern is using the drugs for many years to prevent osteoporosis. They can reduce the risk of hip fractures, but there are now many different alternatives for women to maintain bone density, such as bisphosphonates or raloxifene. Hormone replacement therapy should only be considered after all other options have failed.

It's the caged-mouse syndrome of air travel -- you feel crammed into your seat on a long-distance flight with little to munch on except a bag of pretzels.But you better hope you beat jet lag better than a mouse.A study at the University of Virginia released during the height of Thanksgiving and Christmas travel seasons showed that a majority of elderly mice died while being subjected to the equivalent of a Washington-to-Paris flight once a week for eight weeks. More intense forms of jet lag sped up the death rate in the elderly rodents, the study found.For decades, flyers have stoically battled the modern-age problem of jet lag, viewing its accompanying grogginess, burning eyes, headaches, insomnia and fatigue as more of a nuisance than a potential health issue.The study has focused new attention on the problem and raised questions about whether severe jet lag can be harmful to health. It also has drawn attention to work by other researchers looking into ways to help vacationing families and business travelers avoid jet lag. The study is one of the first hard scientific looks into the health effects of jet lag, experts said.The condition has become such a common scourge of the jet age that an entire industry has emerged on the Internet, offering such solutions as acupressure kits, homeopathic pills and light-enhancing visors. Many travelers have invented their own treatments: slurping down gallons of coffee, dunking heads in ice-cold water, taking naps, jogging and popping sleeping pills and homeopathic remedies. But researchers say few of those remedies are backed by science.In the study, younger mice seemed to rebound more quickly and were not immediately harmed by the jet lag. Simulated jet lag conditions were created by advancing and delaying the rodent's exposure to light.Researchers aren't sure what conclusions to draw from the results.Gene Block, the report's co-author, said older mice might be more susceptible to sudden light changes than younger mice. Or, he said, jet lag might be a health problem that builds up in younger subjects, causing future maladies.To further explore the issue, his researchers have launched another set of tests to determine whether jet lag causes long-term health consequences in younger and middle-age rodents, Block said minutes before boarding a 14-hour flight to Japan from Washington."I feel like a subject in the experiment," said the 58-year-old, who recently returned from a conference in Italy. "Like many people, I am finding it more difficult to cope with jet lag as I get older. . . . I would like to know whether it's a phenomenon of old age or whether it is something I really have to worry about."Block's study also hinted at what flyers have been saying for years: It is more difficult to adjust to time zone changes when flying east. The researchers found that 53 percent of elderly mice died when they were subjected to a simulated weekly flight from Washington to Paris over the eight-week study. The death rate dropped to 32 percent of elderly mice on a simulated Paris-to-Washington route, according to the study, which was published last month in the journal Current Biology. Seventeen percent of the mice in a control group died in the eight-week study.Research has identified links between night-shift work and chronic health problems. And doctors and aviation experts have worked hard to help pilots and flight attendants mitigate the effects of jet lag to ensure they can function properly in the air.Jet lag is caused when people fly across time zones. Many factors, including daylight, sleep cycles, hormones and other natural rhythms, play a role in how humans' complicated internal clocks handle it.Researchers say the only way to truly avoid jet lag is for travelers to gradually prepare before leaving on their trips.Charmane I. Eastman, a professor and director of the Biological Rhythms Research Lab at Rush University Medical Center in Chicago, believes that flyers can more easily cope with jet lag by adjusting their sleep schedules before traveling.If headed east from the Washington area, for example, travelers should go to bed an hour earlier each night and wake up an hour earlier each morning for several days before leaving town.When travelers wake up, they should get sunlight or use a "light box" to help trigger changes in their biological clocks. Travelers should also consider taking small amounts of melatonin, a hormone, five hours before going to sleep to help them adjust to their future time zone, Eastman said.The only other way to avoid jet lag on overseas trips: "Take a boat," she said.There are also ways to mitigate jet lag once you land. If heading to Europe from Washington, most people should wear dark sunglasses after landing until about 11 a.m. Exposure to too much light too early can delay adjustment to new time zones, Eastman said.After 11 a.m., travelers should try to get as much sunlight as possible to help kick-start the body's clock, she said.Several veteran travelers said they would have a difficult time switching schedules under Eastman's plan and said booking a cruise was an inefficient option.They have found their own ways to cope.Steve Solomon, 30, a consultant who lives in Gaithersburg, sets his watch to his destination's time zone before he takes off "to get your mind into the right mind-set." He also avoids alcohol and drinks a lot of water."I view it as more of a hassle than anything else," he said. "You have to run with the punches."Carol Lane, a 42-year-old free-lance advertising and marketing writer, says she relies on homeopathic pills she buys at a health food store.Even with the pills, though, she said she hadn't been able to adjust to jet lag as well as she did a few years ago."When you are in a particularly bad bout, you are just so walloped," she said. "I'm an old mouse, I guess."

THE VACCINE TO PREVENT EVERY STRAIN OF FLU: British scientists are on the verge of producing a revolutionary flu vaccine that works against all major types of the disease. Described as the 'holy grail' of flu vaccines, it would protect against all strains of influenza A - the virus behind both bird flu and the nastiest outbreaks of winter flu. Just a couple of injections could give long-lasting immunity - unlike the current vaccine which has to be given every year. The brainchild of scientists at Cambridge biotech firm Acambis, working with Belgian researchers, the vaccine will be tested on humans for the first time in the next few months.

The Health-Harming Confusion About SaturatedFatsToo Much Exercise is Just as Bad as Not Enough10 Steps to Being Happier and HealthierMore Evidence Ginkgo Biloba Works Just as Wellas Dementia DrugsDo Not Drink Airplane WaterAfter-Dinner Snacks Can Aid in Weight LossEating Artifical Sweeteners Triggers AppetiteRed Grapefruit Lowers LDL CholesterolAnother Reason to Eat Your Vegetables: Loweringthe Risk of Diabetes_________________________________________

_________________________________________

The Health-Harming Confusion About SaturatedFats

DiabetesWhile studies have shown that consumingsaturated fat can slightly increase insulin levels,which can be a risk factor for type-2 diabetes, thestudies did not reflect real-world diets, and did notreflect the fatty acid profiles consumed in normaldiets. In addition, recommendations to avoidsaturated fats generally result in people consumingmore trans fats, which are definitely dangerous.Trans fats have a detrimental effect on theincidence and treatment of type-2 diabetes, whilesaturated fats have been shown to have no effectwhen appropriate comparisons are made.

Trans fats interfere with insulin receptors, whilesaturated fats do not. Type-2 diabetes did not exist100 years ago, when the human diet was very richin saturated fats; it appeared when trans fats cameinto the diet.

As people eat more and more foods containingtrans fats, it has become an epidemic.

After a number of years in which almost no deathswere caused by heart attacks during marathons, atleast six runners have died in 2006. Somephysicians, including Dr. Arthur Siegel, author ofnumerous studies of Boston Marathon racers,believe that the extended races put the heart atrisk.

A new study by Dr. Siegel and colleagues examined60 Boston Marathon entrants. The runners showednormal cardiac function before the marathon.But 20 minutes after finishing, 60 percent of thegroup had elevated levels of troponin (a protein thatshows up in the blood when the heart istraumatized), and 40 percent had levels highenough to indicate the destruction of heart musclecells. Many also showed noticeable changes inheart rhythms.

Another study, from Germany, showed that as manyas one-third of middle-aged male marathoners mayhave higher than expected calcium plaque depositsin their arteries, putting them at a greater risk forheart attack.

Just over 20 percent of a control group of non-runners had comparable calcium plaque buildup.

Researchers at the National Institute on Aging havedetermined that well-being is strongly influenced byindividual characteristics. Their 10-year studyshowed people with a happy disposition in 1973were still happy in 1983, even if their job, location, ormarital status had changed.

If you want to create positive emotions, but don'tknow where to begin, the links below will bringhappiness into your life. Here's a sampling:

1. Stop trying to be perfect. Don’t expect perfectionfrom yourself or from anybody. You don’t need toimpress people around you and you don’t have toget everything done perfectly.

2. Be happy and satisfied with what you have.Stop comparing with others at every stage, this willinfact add to your misery. Be happy and content withyour life. Remove the feelings of jealousyand enemity.

3. Schedule some time for yourself. Give yourselfone hour each day when you can truly relax andenjoy yourself. Do some exercise, work on ahobby, go for a walk, or read a book.Pamper youself with some massages orbeauty therapies. Meditate or pray to God. This willrenew your energy and concentration.

4. If you are too stressed at work, take a break andrefresh your energy. Go for a holiday with yourfamily and friends. Explore new places. Takingbreaks helps your body recover the lost energy. Youmay take short or long breaks, depending on yourwork and stress levels. When you get back to workafter a break, your concentration and focusimproves a great deal and you are more motivated.5. Don’t be alone all the time. Go out withyour friends and talk to them on the phone regularly.Watch a movie, go shopping or do things that youalways loved but did not get the time becauseof your busy schedules. Call your friends home andwatch a funny movie together.

6. If you are a working parent, take a break fromwork and spend time with your kids. Or play withyour pets. Visit your relatives and throwa party for them. Dance and sing with them.

7. Be grateful to people around you. Be thankful foreven small favours and blessings.

8. Help Others. It has been observed that helpingothers gives you immense satisfaction andhappiness. Make someone’s life more beautiful bycontributing in your own small way.

9. Re-assess your priorties. Spend time with yourfamily and pray to God. Stay in the present. Do notwaste time regretting your past or worrying aboutthe future.

10. Laugh out loud atleast once in a day and keepsmiling. Focus on things that keep you happyinstead of those that keep you down. Forget yourworries and pains, everybody in this world, hassome problems. But it all depends on the way youdeal with it.

An Italian study has determined that ginkgo bilobaworks just as well as Aricept (donepezil) in treatingmild or moderate Alzheimer's-related dementia.

For the study, 76 mild-to-moderate dementiapatients received either a placebo, ginkgo or Ariceptfor six months, followed by a four-week course of aplacebo to exclude those reactions.

During the study period, more ginkgo patientsdropped out of the test, but not for the samereasons as the four Aricept dropouts, who left due toadverse drug reactions.

Based on test scores to determine the severity ofdementia afterward, scientists agreed both ginkgobiloba and Aricept work just as effectively to slowdown the damage.

European Journal of Neurology September 2006;13(9): 981-985_________________________________________

Do Not Drink Airplane Water

According the the Environmental Protection Agencytap water on more than 17 percent of flights recentlytested contained disease-causing bacteria,including E.coli. Bring your own bottled water._________________________________________

After-Dinner Snacks Can Aid in Weight Loss

Recent research has found that a lower calorie,higher fiber snack about 90 minutes after dinner[such as an apple or pear] can reduce the cravingsfor higher calorie late night snacks that lead toweight gain in many over-weight individuals]._________________________________________

Eating Artifical Sweeteners Triggers Appetite

Researchers have found that eating artificalsweeteners encourages your body to increase itscalorie intake. A better alternative to either artificalsweeteners or sugar is Stevia, a natural zero-caloriealternative that is sold as an herbal supplement.

Recent research has found that even in individualswho do not responde to statin drugs have afavorable cholesterol lowering response to eatingred grapefruit. Eating one red grapefruit daily forfour weeks demonstrated a 20 percent reduction inLDL cholesterol.

MONTEREY, Calif.--On Monday, Arnold Schwarzenegger presented his proposal for reducing the number of Californians who lack health insurance. His proposal is almost indistinguishable--except in details--from that of the Democrats who dominate the California Assembly and Senate.

The Democrats tend to favor solutions involving regulations, government spending and taxes, and Senate President Pro Tem Don Perata's proposal--the main contending Democrat plan--hits the trifecta. It would require employers to provide health insurance; give them the option of paying a tax instead of providing health insurance; and increase spending by expanding both the Medi-Cal and Healthy Families programs, which provide care to low-income children--including children of illegal immigrants and the disabled.

Mr. Schwarzenegger's solution hits the trifecta also. He would require employers with 10 or more workers to provide health insurance or pay a 4% tax on all wages covered by Social Security: Look for employers with 10 to 12 employees to get creative about outsourcing. And look as well, as Harvard economist Jonathan Gruber has documented, for wages to fall in firms that offer health insurance because of the mandate. Gov. Schwarzenegger would throw in a 2% tax on doctors and a 4% tax on hospitals to help fund Medi-Cal, California's name for Medicaid. And he would expand Medi-Cal to adults earning as much as 100% above the poverty line and to children, even those here illegally, in poor and middle-income families. He hopes, by doing this, to shift $5 billion of Medi-Cal's annual cost to the federal government.

There are two problems with such solutions. First, they infringe on economic freedom, preventing, in Robert Nozick's phrase, "capitalist acts between consenting adults." Second, government solutions rarely work.

Why doesn't increased government power tend to solve the problem of the uninsured? There are two main reasons. First, when government provides health insurance, many people who take advantage of it drop their own privately provided health insurance. In a 1996 article in the Quarterly Journal of Economics, Harvard economists David M. Cutler and Jonathan Gruber found a 50% "crowding-out effect." As the federal Medicaid program expanded, for every two people who gained insurance through Medicaid, one dropped private health insurance. Although this is a net addition of one, the costs to taxpayers are much higher than expected because now half of the newly covered, instead of paying their own way as they previously did, become wards of the state. Second, of the 46 million or so people without health insurance at any given time, about 45% will have health insurance within four months. This is one of the main findings of a 2003 study by the Congressional Budget Office, "How Many People Lack Health Insurance and for How Long?" That shouldn't be surprising in a country where most private health insurance is employer-provided and most unemployment spells last 11 weeks or less. Solutions that involve government mandates on employers or employees will, therefore, miss connecting with about half of the people who are uninsured at a given point in time.

But what if the governor could solve some of the problem by making health insurance cheaper? He can--not by regulating more, but by deregulating.

Let me explain. In the last few decades, state governments, the main regulators of health insurance in the individual and small-group markets, have mandated coverages for many kinds of health care. According to the Council for Affordable Health Insurance (CAHI), a pro-market association of insurance carriers, there were 1,843 state mandates in 2006. Among the most common, and most expensive, mandates are chiropractic care, treatment for alcoholism and drug abuse, and mental health benefits. California's government mandates coverage for all of the above, as well as for many other benefits, including, for example, infertility treatment--a very expensive benefit.

Abolishing these mandates would allow people who don't want to be covered for these things to buy cheaper insurance, while still allowing those who want them to buy and pay for them. Would such an approach work? That's like asking whether, if the government currently required new cars to have CD players, eliminating that requirement would lower the price of a car. Of course it would work.

It is important, though, not to overstate its benefits. The gain to Californians from abolishing these mandates would not be huge. CAHI compiled data from America's Health Insurance plan and eHealthInsurance for the individual market and from the federal government for the small-group market and found that in 2003, although California had more mandated coverages than all but six other states, it had among the lowest insurance rates for individual health insurance policies ($1,885 versus a top rate of $6,048 for New Jersey.)

The reason, explains CAHI, is that in other ways California is much less regulatory than many other states. It does not, for example, require guaranteed issue on individual policies--which drives up premiums by forcing insurance companies to supply policies to all comers, regardless of health status. Yet the governor's proposal would reverse this somewhat and prevent insurance companies from saying no because of age and health.

California should not, contra Gov. Schwarzenegger, do new regulatory harm; rather it should repeal existing regulations that cause harm--so as to make health insurance even more affordable.There is one other way to deregulate: The California government could allow any Californian to buy health insurance from any willing insurer in any state and be subject to the regulations of that state. That way, people could shop for the degree of paternalism they want. If they want insurance from a state that requires many coverages, they could do so and pay the high premiums that result. If they want bare-bones coverage, they could do so also. The result would surely be that some of the current uninsured would buy insurance. Were I in the market for individual insurance and given the choice, I would not bother paying for coverage for alcohol or drug abuse.

If a version of Gov. Schwarzenegger's plan passes, the only thing certain is that there will be more regulation, more government spending and more taxes. A better path would be to deregulate, and thus achieve some increase in the number of insured--without new spending or taxes or regulation.

Mr. Henderson, a research fellow at Stanford's Hoover Institution, was the senior economist for health policy with President Reagan's Council of Economics Advisers (1982-84). He is co-author of "Making Great Decisions in Business and Life" (Chicago Park Press, 2006).

Another C -- circumcision -- looks set to be added to the “Abstain, Be Faithful and Condomise” HIV prevention campaigns after conclusive evidence emerged this week that removing a man’s foreskin can halve his chances of catching HIV.

Two clinical trials, in Uganda and Kenya, have confirmed previous South African research into the protective power of circumcision.

The news has been hailed as one of the most significant breakthroughs in the fight against HIV for years, with the potential to prevent millions of new infections.

Circumcision as a prevention measure is not a part of the South African government’s draft strategic plan on HIV/Aids, although Aids experts expect this now to change rapidly.

The way is open for governments and funders to roll out mass circumcision campaigns and several of the biggest donor organisations are said to be looking at providing funding.

No African country has yet adopted mass circumcision as a policy, although several countries have been discussing the measure. And some, such as Kenya, have created task teams to tackle implementation.

Swaziland has “circumcision Sundays” to encourage men to undergo the operation.

The Kenyan and Ugandan clinical trials were terminated early, after preliminary research found that circumcision was so safe and effective that it would be unethical not to offer the operation to the uncircumcised control group.

In 2005 a similar trial in South Africa’s Orange Farm was also halted on ethical grounds after it found at least a two-thirds reduction in new HIV infections among circumcised men. Research into whether circumcision also protects female sexual partners from HIV infection is ongoing, although there is indirect evidence suggesting it will.

Male circumcision as a public health measure has been controversial, with some arguing that it is mutilation. There is also concern that circumcised men may practise riskier sex out of over-confidence, and that circumcision may be culturally inappropriate.

However, studies in Africa indicate most men would have the operation as protection against HIV, even if circumcision is not part of their culture.

Anthony Fauci, the director of the National Institute of Allergic and Infectious Diseases, which oversaw the latest research, said there did not seem to be a significant rise in risky sex among circumcised men, although this would continue to be monitored. As circumcision confers only partial protection, men and their partners are still urged to practise safer sex, especially condom usage.

“This data is going to put some people on the spot,” said Harvard researcher Daniel Halperin, who has advocated expanding circumcision for several years. “The response of the international agencies and donors will be crucial. Many people were basically putting aside the Orange Farm data and saying lets see what Uganda and Kenya show. It’s now shown to be at least 50% to 60% effective. Considering how many people are dying from this disease, that is a rather powerful result. Circumcision services need to be made available, safe and affordable.

“The ideal scenario now would be an increase in male circumcision and a decrease in concurrent sexual partners, probably the two strongest things impacting on the spread of HIV, along with consistent condom use.”

In the Kenyan trial, involving 2 784 men, circumcision reduces participants’ risk of catching HIV by 53%. In the Ugandan research there was 48% reduction among the 4 996 participants.

The protective effect is the result of the removal of the mucosal inner lining of the foreskin, which is far more vulnerable to HIV infection than vaginal mucus membranes. An uncircumcised penis also provides a comfortable environment for other sexually transmitted diseases, in turn providing a portal into the body for HIV.

The challenge will now be to be to spread the news among men and their partners, and to implement safe mass circumcision campaigns. One danger is that men may use unregulated and risky circumcision providers, such as “initiation” schools.

In South Africa, the most common method is to use forceps and scissors to slice off the unwanted piece of skin. The wound is cauterised and stitched with dissolvable thread, and healing takes, at most, six weeks.

The procedure is often carried out under local anaesthetic injected into the base of the penis.

But there is growing research into other techniques, including “bloodless” procedures where the foreskin is held tightly in a clamp for several days until the blood-starved skin dies and drops off. Involuntary erections can, however, interfere with the procedure, while the different kinds of clamp need to be sized to fit each individual man.

Other options being examined are surgical glue rather than stitching, because it is fast and potentially less vulnerable to infection. However, the highly adhesive glue could lead to serious -- and potentially permanent -- problems if applied accidentally to the wrong areas.

On a spring afternoon several years ago, Evan McKinley was hiking in the woods near Halifax, Nova Scotia, when he felt a sharp pain in his chest. McKinley (a pseudonym) was a forest ranger in his early forties, trim and extremely fit. He had felt discomfort in his chest for several days, but this was more severe: it hurt each time he took a breath. McKinley slowly made his way through the woods to a shed that housed his office, where he sat and waited for the pain to pass. He frequently carried heavy packs on his back and was used to muscle aches, but this pain felt different. He decided to see a doctor.

Pat Croskerry was the physician in charge in the emergency room at Dartmouth General Hospital, near Halifax, that day. He listened intently as McKinley described his symptoms. He noted that McKinley was a muscular man; that his face was ruddy, as would be expected of someone who spent most of his day outdoors; and that he was not sweating. (Perspiration can be a sign of cardiac distress.) McKinley told him that the pain was in the center of his chest, and that it had not spread into his arms, neck, or back. He told Croskerry that he had never smoked or been overweight; had no family history of heart attack, stroke, or diabetes; and was under no particular stress. His family life was fine, McKinley said, and he loved his job.

Croskerry checked McKinley’s blood pressure, which was normal, and his pulse, which was sixty and regular—typical for an athletic man. Croskerry listened to McKinley’s lungs and heart, but detected no abnormalities. When he pressed on the spot between McKinley’s ribs and breastbone, McKinley felt no pain. There was no swelling or tenderness in his calves or thighs. Finally, the doctor ordered an electrocardiogram, a chest X-ray, and blood tests to measure McKinley’s cardiac enzymes. (Abnormal levels of cardiac enzymes indicate damage to the heart.) As Croskerry expected, the results of all the tests were normal. “I’m not at all worried about your chest pain,” Croskerry told McKinley, before sending him home. “You probably overexerted yourself in the field and strained a muscle. My suspicion that this is coming from your heart is about zero.”

Early the next evening, when Croskerry arrived at the emergency room to begin his shift, a colleague greeted him. “Very interesting case, that man you saw yesterday,” the doctor said. “He came in this morning with an acute myocardial infarction.” Croskerry was shocked. The colleague tried to console him. “If I had seen this guy, I wouldn’t have gone as far as you did in ordering all those tests,” he said. But Croskerry knew that he had made an error that could have cost the ranger his life. (McKinley survived.) “Clearly, I missed it,” Croskerry told me, referring to McKinley’s heart attack. “And why did I miss it? I didn’t miss it because of any egregious behavior, or negligence. I missed it because my thinking was overly influenced by how healthy this man looked, and the absence of risk factors.”

Croskerry, who is sixty-four years old, began his career as an experimental psychologist, studying rats’ brains in the laboratory. In 1979, he decided to become a doctor, and, as a medical student, he was surprised at how little attention was paid to what he calls the “cognitive dimension” of clinical decision-making—the process by which doctors interpret their patients’ symptoms and weigh test results in order to arrive at a diagnosis and a plan of treatment. Students spent the first two years of medical school memorizing facts about physiology, pharmacology, and pathology; they spent the last two learning practical applications for this knowledge, such as how to decipher an EKG and how to determine the appropriate dose of insulin for a diabetic. Croskerry’s instructors rarely bothered to describe the mental logic they relied on to make a correct diagnosis and avoid mistakes.

In 1990, Croskerry became the head of the emergency department at Dartmouth General Hospital, and was struck by the number of errors made by doctors under his supervision. He kept lists of the errors, trying to group them into categories, and, in the mid-nineties, he began to publish articles in medical journals, borrowing insights from cognitive psychology to explain how doctors make clinical decisions—especially flawed ones—under the stressful conditions of the emergency room. “Emergency physicians are required to make an unusually high number of decisions in the course of their work,” he wrote in “Achieving Quality in Clinical Decision Making: Cognitive Strategies and Detection of Bias,” an article published in Academic Emergency Medicine, in 2002. These doctors’ decisions necessarily entail a great deal of uncertainty, Croskerry wrote, since, “for the most part, patients are not known and their illnesses are seen through only small windows of focus and time.” By calling physicians’ attention to common mistakes in medical judgment, he has helped to promote an emerging field in medicine: the study of how doctors think.

There are limited data about the frequency of misdiagnoses. Research from the nineteen-eighties and nineties suggests that they occur in about fifteen per cent of cases, but Croskerry suspects that the rate is significantly higher. He believes that many misdiagnoses are the result of readily identifiable—and often preventable—errors in thinking.

Doctors typically begin to diagnose patients the moment they meet them. Even before they conduct an examination, they are interpreting a patient’s appearance: his complexion, the tilt of his head, the movements of his eyes and mouth, the way he sits or stands up, the sound of his breathing. Doctors’ theories about what is wrong continue to evolve as they listen to the patient’s heart, or press on his liver. But research shows that most physicians already have in mind two or three possible diagnoses within minutes of meeting a patient, and that they tend to develop their hunches from very incomplete information. To make diagnoses, most doctors rely on shortcuts and rules of thumb—known in psychology as “heuristics.”

Heuristics are indispensable in medicine; physicians, particularly in emergency rooms, must often make quick judgments about how to treat a patient, on the basis of a few, potentially serious symptoms. A doctor is trained to assume, for example, that a patient suffering from a high fever and sharp pain in the lower right side of the abdomen could be suffering from appendicitis; he immediately sends the patient for X-rays and contacts the surgeon on call. But, just as heuristics can help doctors save lives, they can also lead them to make grave errors. In retrospect, Croskerry realized that when he saw McKinley in the emergency room the ranger had been experiencing unstable angina—a surge of chest pain that is caused by coronary-artery disease and that may precede a heart attack. “The unstable angina didn’t show on the EKG, because fifty per cent of such cases don’t,” Croskerry said. “His unstable angina didn’t show up on the cardiac-enzymes test, because there had been no damage to his heart muscle yet. And it didn’t show up on the chest X-ray, because the heart had not yet begun to fail, so there was no fluid backed up in the lungs.”

The mistake that Croskerry made is called a “representativeness” error. Doctors make such errors when their thinking is overly influenced by what is typically true; they fail to consider possibilities that contradict their mental templates of a disease, and thus attribute symptoms to the wrong cause. Croskerry told me that he had immediately noticed the ranger’s trim frame: most fit men in their forties are unlikely to be suffering from heart disease. Moreover, McKinley’s pain was not typical of coronary-artery disease, and the results of the physical examination and the blood tests did not suggest a heart problem. But, Croskerry emphasized, this was precisely the point: “You have to be prepared in your mind for the atypical and not be too quick to reassure yourself, and your patient, that everything is O.K.” (Croskerry could have kept McKinley under observation and done a second cardiac-enzyme test or had him take a cardiac stress test, which might have revealed the source of his chest pain.) When Croskerry teaches students and interns about representativeness errors, he cites Evan McKinley as an example.

Doctors can also make mistakes when their judgments about a patient are unconsciously influenced by the symptoms and illnesses of patients they have just seen. Many common infections tend to occur in epidemics, afflicting large numbers of people in a single community at the same time; after a doctor sees six patients with, say, the flu, it is common to assume that the seventh patient who complains of similar symptoms is suffering from the same disease. Harrison Alter, an emergency-room physician, recently confronted this problem. At the time, Alter was working in the emergency room of a hospital in Tuba City, Arizona, which is situated on a Navajo reservation. In a three-week period, dozens of people had come to his hospital suffering from viral pneumonia. One day, Blanche Begaye (a pseudonym), a Navajo woman in her sixties, arrived at the emergency room complaining that she was having trouble breathing. Begaye was a compact woman with long gray hair that she wore in a bun. She told Alter that she had begun to feel unwell a few days earlier. At first, she said, she had thought that she had a bad head cold, so she had drunk orange juice and tea, and taken a few aspirin. But her symptoms had got worse. Alter noted that she had a fever of 100.2 degrees, and that she was breathing rapidly—at almost twice the normal rate. He listened to her lungs but heard none of the harsh sounds, called rhonchi, that suggest an accumulation of mucus. A chest X-ray showed that Begaye’s lungs did not have the white streaks typical of viral pneumonia, and her white-blood-cell count was not elevated, as would be expected if she had the illness.

However, a blood test to measure her electrolytes revealed that her blood had become slightly acidic, which can occur in the case of a major infection. Alter told Begaye that he thought she had “subclinical pneumonia.” She was in the early stages of the infection, he said; the virus had not yet affected her lungs in a way that would show up on a chest X-ray. He ordered her to be admitted to the hospital and given intravenous fluids and medicine to bring her fever down. Viral pneumonia can tax an older person’s heart and sometimes cause it to fail, he told her, so it was prudent that she remain under observation by doctors. Alter referred Begaye to the care of an internist on duty and began to examine another patient.

A few minutes later, the internist approached Alter and took him aside. “That’s not a case of viral pneumonia,” the doctor said. “She has aspirin toxicity.”

Immediately, Alter knew that the internist was right. Aspirin toxicity occurs when patients overdose on the drug, causing hyperventilation and the accumulation of lactic acid and other acids in the blood. “Aspirin poisoning—bread-and-butter toxicology,” Alter told me. “This was something that was drilled into me throughout my training. She was an absolutely classic case—the rapid breathing, the shift in her blood electrolytes—and I missed it. I got cavalier.”

Alter’s misdiagnosis resulted from the use of a heuristic called “availability,” which refers to the tendency to judge the likelihood of an event by the ease with which relevant examples come to mind. This tendency was first described in 1973, in a paper by Amos Tversky and Daniel Kahneman, psychologists at the Hebrew University of Jerusalem. For example, a businessman may estimate the likelihood that a given venture could fail by recalling difficulties that his associates had encountered in the marketplace, rather than by relying on all the data available to him about the venture; the experiences most familiar to him can bias his assessment of the chances for success. (Kahneman won the Nobel Prize in Economics in 2002, for his research on decision-making under conditions of uncertainty.) The diagnosis of subclinical pneumonia was readily available to Alter, because he had recently seen so many cases of the infection. Rather than try to integrate all the information he had about Begaye’s illness, he had focussed on the symptoms that she shared with other patients he had seen: her fever, her rapid breathing, and the acidity of her blood. He dismissed the data that contradicted his diagnosis—the absence of rhonchi and of white streaks on the chest X-ray, and the normal white-blood-cell count—as evidence that the infection was at an early stage. In fact, this information should have made him doubt his hypothesis. (Psychologists call this kind of cognitive cherry-picking “confirmation bias”: confirming what you expect to find by selectively accepting or ignoring information.)

After the internist made the correct diagnosis, Alter recalled his conversation with Begaye. When he had asked whether she had taken any medication, including over-the-counter drugs, she had replied, “A few aspirin.” As Alter told me, “I didn’t define with her what ‘a few’ meant.” It turned out to be several dozen.

Representativeness and availability errors are intellectual mistakes, but the errors that doctors make because of their feelings for a patient can be just as significant. We all want to believe that our physician likes us and is moved by our plight. Doctors, in turn, are encouraged to develop positive feelings for their patients; caring is generally held to be the cornerstone of humanistic medicine. Sometimes, however, a doctor’s impulse to protect a patient he likes or admires can adversely affect his judgment.

In 1979, I treated Brad Miller (a pseudonym), a young literature instructor who was suffering from bone cancer. I was living in Los Angeles at the time, completing a fellowship in hematology and oncology at the U.C.L.A. Medical Center. “You look familiar,” Brad said to me when I introduced myself to him in his hospital room as the doctor who would be overseeing his care. “I see you running with two or three friends around the university,” he said. “I’m a runner, too—or, at least, was.”

I told Brad that I hoped he would be able to run again soon, though I warned him that his chemotherapy treatment would be difficult.

About six weeks earlier, Brad had noticed an ache in his left knee. He had been training to run in a marathon, and at first he thought that the ache was caused by a sore muscle. He saw a specialist in sports medicine, who examined the leg and recommended that he wear a knee brace when he ran. Brad followed this advice, but the ache got worse. The physician ordered an X-ray, which showed an osteosarcoma, a cancerous growth, around the end of the femur, just above the knee.

Several years earlier, the surgical-oncology department at U.C.L.A. had devised an experimental treatment for this kind of sarcoma, involving a new chemotherapy drug called Adriamycin. Oncologists had nicknamed Adriamycin “the red death,” because of its cranberry color and its toxicity. Not only did it cause severe nausea, vomiting, mouth blisters, and reduced blood counts; repeated doses could injure cardiac muscle and lead to heart failure. Patients had to be monitored closely, since once the heart is damaged there is no good way to restore its pumping capacity. Still, doctors at U.C.L.A. had found that giving patients multiple doses of Adriamycin often shrank tumors, allowing them to surgically remove the cancer without amputating the affected limb—the standard approach in the past.

I began administering the treatment that afternoon. Despite taking Compazine to stave off vomiting, Brad was acutely nauseated. After several doses of chemotherapy, his white-blood-cell count dropped precipitately. Because his immune system was weakened, he was at great risk of contracting an infection. I required visitors to Brad’s room to wear a mask, a gown, and gloves, and instructed the nurses not to give him raw food, in order to limit his exposure to bacteria.

“Not to your taste,” I said at the end of the first week of treatment, seeing an untouched meal on his tray.

“My mouth hurts,” Brad whispered. “And, even if I could chew, it looks pretty tasteless.”

I agreed that the food looked dismal.

“What is to your taste?” I asked. “Fried kidney?”

I had told Brad when we met that I had studied “Ulysses” in college, in a freshman seminar. The professor had explained the relevant Irish history, the subtle references to Catholic liturgy, and a number of other allusions that most of us in the class would otherwise not have grasped. I had enjoyed Joyce’s descriptions of Leopold Bloom eating fried kidneys.

Brad was my favorite patient on the ward. Each morning when I made rounds with the residents and the medical students, I would take an inventory of his symptoms and review his laboratory results. I would often linger a few moments in his room, trying to distract him from the misery of his therapy by talking about literature.

The treatment called for a CAT scan after the third cycle of Adriamycin. If the cancer had shrunk sufficiently, the surgery would proceed. If it hadn’t, or if the cancer had grown despite the chemotherapy, then there was little to be done short of amputation. Even after amputation, patients with osteosarcomas are at risk of a recurrence.

One morning, Brad developed a low-grade fever. During rounds, the residents told me that they had taken blood and urine cultures and that Brad’s physical examination was “nonfocal”—they had found no obvious reason for the fever. Patients often get low fevers during chemotherapy after their white-blood-cell count falls; if the fever has no identifiable cause, the doctor must decide whether and when to administer a course of antibiotics.

“So you feel even more wiped out?” I asked Brad.

He nodded. I asked him about various symptoms that could help me determine what was causing the fever. Did he have a headache? Difficulty seeing? Pressure in his sinuses? A sore throat? Problems breathing? Pain in his abdomen? Diarrhea? Burning on urination? He shook his head.

Two residents helped prop Brad up in bed so that I could examine him; I had a routine that I followed with each immune-deficient patient, beginning at the crown of the head and working down to the tips of the toes. Brad’s hair was matted with sweat, and his face was ashen. I peered into his eyes, ears, nose, and throat, and found only some small ulcers on his inner cheeks and under his tongue—side effects of his treatment. His lungs were clear, and his heart sounds were strong. His abdomen was soft, and there was no tenderness over his bladder.

“Enough for today,” I said. Brad looked exhausted; it seemed wise to let him rest.

Later that day, I was in the hematology lab, looking at blood cells from a patient with leukemia, when my beeper went off. “Brad Miller has no blood pressure,” the resident told me when I returned the call. “His temperature is up to a hundred and four, and we’re moving him to the I.C.U.”

Brad was in septic shock. When bacteria spread through the bloodstream, they can damage the circulation. Septic shock can be fatal even in people who are otherwise healthy; patients with impaired immunity, like Brad, whose white-blood-cell count had fallen because of chemotherapy, are at particular risk of dying.

“Do we have a source of infection?” I asked.

“He has what looks like an abscess on his left buttock,” the resident said.

Patients who lack enough white blood cells to fight bacteria are prone to infections at sites that are routinely soiled, like the area between the buttocks. The abscess must have been there when I examined Brad. But I had failed to ask him to roll over so that I could inspect his buttocks and rectal area.

The resident told me that he had repeated Brad’s cultures and started him on broad-spectrum antibiotics, and that the I.C.U. team was about to take over.

I was furious with myself. Because I liked Brad, I hadn’t wanted to add to his discomfort and had cut the examination short. Perhaps I hoped unconsciously that the cause of his fever was trivial and that I would not find evidence of an infection on his body. This tendency to make decisions based on what we wish were true is what Croskerry calls an “affective error.” In medicine, this type of error can have potentially fatal consequences. In the case of Evan McKinley, for example, Pat Croskerry chose to rely on the ranger’s initial test results—the normal EKG, chest X-ray, and blood tests—all of which suggested a benign diagnosis. He didn’t arrange for follow-up testing that might have revealed the source of the ranger’s chest pain. Croskerry, who had been an Olympic rower in his thirties, told me that McKinley had reminded him of himself as an athlete; he believed that this association contributed to his misdiagnosis.

As soon as I finished my work in the lab, I rushed to the I.C.U. to check on Brad. He was on a respirator and opened his eyes wide to signal hello. Through an intravenous line attached to one arm, he was receiving pressors, drugs that cause the heart to pump more effectively and increase the tone of the vessels to help maintain blood pressure. Brad’s heart was holding up, despite all the Adriamycin he had taken. His platelet count had fallen, as often happens with septic shock, and he was receiving platelet transfusions. The senior doctor in the I.C.U. had told Brad’s parents, who lived nearby, that he was extremely ill. I saw his parents sitting in a room next to the I.C.U., their heads bowed. They had not seen me, and I was tempted to avoid them. But I forced myself to speak to them and offered a few words of encouragement. They thanked me for my care of their son, which only made me feel worse.

The next morning, I arrived before the residents to review my patients’ charts. Rounds lasted an hour longer than usual, as I insisted on double-checking each bit of information that the residents offered about the patients in our care.

Brad Miller survived. Slowly, his white-blood-cell count increased, and the infection was resolved. After he left the I.C.U., I told him that I should have examined him more thoroughly that morning, but I did not explain why I had not. A CAT scan showed that his sarcoma had shrunk enough for him to undergo surgery without amputation, but a large portion of his thigh muscle had to be removed along with the tumor. After he recovered, he was no longer able to run, but occasionally I saw him riding his bicycle on campus.

Medical education has not changed substantially since Pat Croskerry and I were trained. Students are still expected to assimilate large amounts of basic science and apply that knowledge as they are taught practical aspects of patient care. And young physicians still learn largely by observing more senior members of their field. (“See one, do one, teach one” remains a guiding maxim at medical schools.) This approach produces confident and able physicians. Yet the ideal it implies, of the doctor as a dispassionate and rational actor, is misguided. As Tversky and Kahneman and other cognitive psychologists have shown, when people are confronted with uncertainty—the situation of every doctor attempting to diagnose a patient—they are susceptible to unconscious emotions and personal biases, and are more likely to make cognitive errors. Croskerry believes that the first step toward incorporating an awareness of heuristics and their liabilities into medical practice is to recognize that how doctors think can affect their success as much as how much they know, or how much experience they have. “Currently, in medical training, we fail to recognize the importance of critical thinking and critical reasoning,” Croskerry told me. “The implicit assumption in medicine is that we know how to think. But we don’t.”

Ex-Players Dealing With Not-So-Glamorous Health IssuesBy CLIFTON BROWNNY TimesPublished: February 1, 2007MIAMI, Jan. 31 - Bob Brudzinski turned 52 on Jan. 1, and he considers himself lucky for a man who played 13 seasons as a linebacker with the Los Angeles Rams and the Miami Dolphins. Sometimes, his memory fails him. But he sees former teammates the same age in far worse shape.

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Bob Galbraith/Associated PressReggie White, a Hall of Fame defensive lineman, died at 43 after having cardiac arrhythmia.

"I see guys that I've played with that are depressed; as a matter of fact, guys from college also," said Brudzinski, sitting in a doctor's office about 20 miles from Dolphin Stadium, site of Super Bowl XLI. "It's sad. I don't think they had information back then. If they did, I think they wanted to keep it away from us.

"I can't say the owners and coaches didn't care. They wanted to see how tough you are. Anybody can play not injured. They wanted to see if you can play injured. There were a lot of injections and stuff like that.

"And the other thing is, you didn't want to sit out a game, because there's always somebody behind you who can take your spot. I never thought about concussions, never thought about blowing my knee out. The one thing I really wish is that I could remember more. We used our head too much, in the wrong way."

As concern grows among former N.F.L. players about the impact of football on health, the medical community is working to gather more information. The Living Heart Foundation, the National Football League Players Association and the Baptist Hospital of Miami are sponsoring the third annual Super Bowl Health Screening Program, to examine current and retired players for cardiovascular disease and obstructive sleep apnea. Dozens of former N.F.L. players filed through the office of Dr. Arthur Agatston on Wednesday, being checked for sleep apnea, diabetes, high cholesterol, high blood pressure and other ailments.

Retired players have reason to be concerned about their long-term health. A neuropathologist recently determined that Andre Waters, a former Eagles safety who committed suicide in November at age 44, sustained brain damage from playing football that led to his depression and death. Last month, a United States Court of Appeals upheld a 2005 trial court ruling that the Hall of Fame center Mike Webster sustained brain damage from playing professional football, mostly for the Steelers.

According to a 2003 study published in The New England Journal of Medicine, 14 percent of N.F.L. players had obstructive sleep apnea, a disease that impairs breathing and is known to affect large, muscular individuals like football linemen more often than people of average size. Reggie White, a Hall of Fame defensive lineman, died at 43 in 2004 after having cardiac arrhythmia, but he also had sleep apnea, which may have contributed to his death.

With more football linemen weighing much more than 300 pounds, doctors said they expected sleep apnea to become more prevalent .

"The primary treatment for sleep apnea is to lose weight, and they can't," said Dr. Allan Levy, an associate team physician with the Giants, who is assisting with this week's screening. "There's no such thing as a 225-pound offensive lineman. We try to make certain that they understand that they've got to come down in weight when they retire. All of my offensive lineman from the Giants' two Super Bowl wins have all lost at least 50 pounds. They're all in excellent health. You see some of the other guys, and they're just huge. They've got all kinds of problems.

"The problem with sleep apnea is in the neck. A 17½-inch neck is usually where the problem begins. When they sleep, the muscles relax in the body. Now the weight of their neck clasps down on their airway. They stop breathing. They momentarily wake up, then the cycle starts over again, and they never get into deep sleep. They develop heart disease and hypertension. Sleep apnea is a killer. One of the kids that played for us, we did a sleep study on, had 440 awakenings during the night."

The most common treatment for sleep apnea involves wearing a mask that supplies a stream of air through the nose during sleep. But some retired players have ailments that are far more debilitating. Tom Nowatzke, the president of the N.F.L. Alumni Detroit chapter, said more should be done by the league and the players union to help retired players with disabilities related to football.

"I get $843 a month, but some guys are only getting $300, $400 a month because of when they played," said Nowatzke, a 64-year-old former running back who scored a touchdown for the Baltimore Colts in Super Bowl V.

"Four hundred dollars a month won't pay for a car payment these days, not to mention doctor bills and medicine, and stuff that's not covered. I'm very fortunate to be as healthy as I am at my age. I'm going to see people this weekend who have trouble walking, and they're eight or nine years younger than I am."

Nowatzke said he hoped that more players would stop to think how they may feel when they turn 60 and consider the health of players who have come before them.

"Not many do," Nowatzke said. "Guys who played in the '30s, '40s, '50s probably died before they turned 70. Now guys are living to be 75 or 80. So it becomes a bigger problem."

Top 10 Foods for a Good Night's SleepPosted Tue, Jan 23, 2007, 6:32 pm PST POST A COMMENT »What is the secret to getting a solid 7 to 8 hours of sleep? Head for the kitchen and enjoy one or two of these 10 foods. They relax tense muscles, quiet buzzing minds, and/or get calming, sleep-inducing hormones - serotonin and melatonin - flowing. Yawning yet?

Bananas. They're practically a sleeping pill in a peel. In addition to a bit of soothing melatonin and serotonin, bananas contain magnesium, a muscle relaxant.

Chamomile tea. The reason chamomile is such a staple of bedtime tea blends is its mild sedating effect - it's the perfect natural antidote for restless minds/bodies.

Warm milk. It's not a myth. Milk has some tryptophan - an amino acid that has a sedative - like effect - and calcium, which helps the brain use tryptophan. Plus there's the psychological throw-back to infancy, when a warm bottle meant "relax, everything's fine."

Honey. Drizzle a little in your warm milk or herb tea. Lots of sugar is stimulating, but a little glucose tells your brain to turn off orexin, a recently discovered neurotransmitter that's linked to alertness.

Potatoes. A small baked spud won't overwhelm your GI tract, and it clears away acids that can interfere with yawn-inducing tryptophan. To up the soothing effects, mash it with warm milk.

Oatmeal. Oats are a rich source of sleep - inviting melatonin, and a small bowl of warm cereal with a splash of maple syrup is cozy - plus if you've got the munchies, it's filling too.

Almonds. A handful of these heart-healthy nuts can be snooze-inducing, as they contain both tryptophan and a nice dose of muscle-relaxing magnesium.

Flaxseeds. When life goes awry and feeling down is keeping you up, try sprinkling 2 tablespoons of these healthy little seeds on your bedtime oatmeal. They're rich in omega-3 fatty acids, a natural mood lifter.

Whole-wheat bread. A slice of toast with your tea and honey will release insulin, which helps tryptophan get to your brain, where it's converted to serotonin and quietly murmurs "time to sleep."

Turkey. It's the most famous source of tryptophan, credited with all those Thanksgiving naps. But that's actually modern folklore. Tryptophan works when your stomach's basically empty, not overstuffed, and when there are some carbs around, not tons of protein. But put a lean slice or two on some whole-wheat bread mid-evening, and you've got one of the best sleep inducers in your kitchen.

Depression appears to increase the development of blood vessel plaques, known as atherosclerosis, a condition that can lead to heart attack, stroke, and a host of other cardiovascular problems, according to a report in the Archives of General Psychiatry.

Patients' psychological status influence quality of life, and may also have a "significant impact" on their physical status, including cardiovascular health, Dr. Jesse C. Stewart, from Indiana University-Purdue University Indianapolis, told Reuters Health.

Stewart and colleagues evaluated the contribution of depression, anxiety, and anger to atherosclerosis among 324 men and women between 50 and 70 years old.

Symptom scoring tests evaluated the presence of depression, anxiety and anger, while the extent of atherosclerosis was accessed using an imaging test, which measured the thickness of the walls of the carotid arteries, major blood vessels in the neck that carry oxygen to the brain.

Why Doctors Miss Colon Cancer

An interesting study underscored one more reason, among a seemingly, never-ending number of them, why patients may die from the errors their doctors make: Your physician may be missing signs of colon cancer right in front of him.

Among more than 12,000 colon cancer patients, 430 patients had a new or missed tumor that was diagnosed anywhere from six months to three years after having a colonoscopy. What's more, family physicians and internists who did their own colonoscopies were generally far more prone to miss colon cancer, with women (85 percent) edging men (77 percent).

The other troublesome variable, Canadian researchers discovered, was where a colonoscopy was performed. An office setting tripled the risk of new or missed cancers among men and doubled it among women.Fortunately, there are many natural measures you can take -- none of which have anything to do with a drug, doctor or procedure -- to prevent or fight colon cancer. A few to get you started:

Have your C-reactive protein levels checked and reduce them, if necessary.Get the right amount of exercise.Rebalance the ratio of omega-3 fats you consume by taking a high quality fish oil or krill oil.Eat plenty of vegetables, ideally based on your body's unique metabolic type.

A biological process called AMP-activated protein kinase (AMPK), which boosts muscles, begins to fail with advancing age. This leads to a need for increased effort to achieve the same effects from exercise, and could help explain the link between aging and type 2 diabetes.

AMPK stimulates the body to burn off fat by producing mitochondria, the power sources of cells. The skeletal muscles of athletes have been found to contain a much higher number of mitochondria, which is likely linked to AMPK activity.

When scientists compared the skeletal muscle of 3-month-old rats and 2-year-olds, they found that AMPK was significantly slowed down in older animals. In addition, the muscle of young rats who did more exercise had double the normal AMPK activity, but this effect was not nearly as strong in older rats.

Older people have more fat in their muscles and livers than younger people do. These fat cells have been linked to insulin resistance and type 2 diabetes.

A new study shows that eating fruits and vegetables can improve fertility in men. Researchers from the University of Rochester compared the dietary intake of antioxidants of 10 fertile and 48 infertile men and correlated the findings with sperm motility. Infertile men were twice as likely to have a low intake of fruits and vegetables (fewer than five servings per day) compared with fertile men. Also, men with the lowest overall intake of dietary antioxidants had lower sperm motility than men with higher intakes.

The scientific evidence is strong enough to justify using folic acid as a cheap and simple way of reducing heart disease and strokes.

Debate continues over whether raised homocysteine levels in the blood (an amino acid implicated in the development of arterial disease) causes heart disease and stroke, and whether folic acid, which lowers homocysteine, will help reduce the risk of these disorders. So heart expert, Dr David Wald and colleagues set out to clarify the issue. They examined all the evidence from different studies to see whether raised homocysteine is a cause of cardiovascular disease.

Some studies looked at homocysteine and the occurrence of heart attacks and strokes in large numbers of people (cohort studies), some focused on people with a common genetic variant which increases homocysteine levels to a small extent (genetic studies), while others tested the effects of lowering homocysteine levels (randomised controlled trials).

The conclusion that homocysteine is a cause of cardiovascular disease explains the observations from all the different types of study, even if the results from one type of study are, on their own, insufficient to reach that conclusion, say the authors.

Since folic acid reduces homocysteine concentrations, it follows that increasing folic acid consumption will reduce the risk of heart attack and stroke. They therefore take the view that the evidence is now sufficient to justify action on lowering homocysteine concentrations, although the position should be reviewed as evidence from ongoing clinical trials emerges.

THE video was dark and grainy, the camera operator anonymous. But the clip, which appeared to show a customer at a popular downtown restaurant extracting a disposable glove from a plate of food, caused a small stir on Monday when a link to it was posted at eater.com, a blog that chronicles the New York dining scene.

IS THE SOLUTION A PROBLEM? Employees at a deli wear gloves as they handle ready-to-eat foods. But latex gloves can cause allergic reactions and vinyl gloves contain a chemical that has been called a carcinogen. After a series of restaurant closings by the city’s health department, the amateur video raised new concerns about sanitation practices in restaurant kitchens. The very object that is supposed to keep diners safe from germs appeared to be a menace.

The unusual episode hinted at a larger problem. Twenty years after disposable gloves became common in restaurant kitchens, it is not clear that they prevent the transmission of illness. There are some who argue that the gloves themselves are dangerous to health.

“The typical hand contains millions of bacteria, including harmful ones like staph and strep,” said Elaine Larson, associate dean in the Columbia University School of Nursing and an expert on hand hygiene. “Gloves can prevent most of those bacteria from being transmitted to food.”

But only if the gloves are clean. “The problem is that a worker may never change the gloves or clean them, thinking that the gloves themselves are sufficient protection,” Dr. Larson said. “The trick is to make sure that workers are properly trained.”

That is easier said than done. Thousands of United States restaurant workers were surveyed for a study published in the International Journal of Hygiene and Environmental Health in 2005. More than a third said they did not always change their gloves between touching raw meat or poultry and ready-to-eat food.

Moreover, most gloves are made of latex, a component of natural rubber. Particles of latex can cause allergic reactions not only among people wearing the gloves but also among customers eating food prepared by them. As a result, three states have banned latex gloves in restaurants. In New York a bill has been introduced in the Legislature requiring warning signs in restaurants that use latex gloves.

Many restaurants have switched to gloves made of vinyl, but vinyl contains Di(2-ethylhexyl) phthalate, or DEHP, a chemical that some scientists believe can cause testicular damage in infants and young men. It is also classified as a carcinogen in California. In 2001 Japan banned vinyl gloves from food establishments after large quantities of DEHP were found in food prepared by workers wearing them.

But in the United States, because of latex allergy concerns, vinyl gloves are becoming ever more popular.

Andy Igrejas, the environmental health campaign director at the National Environmental Trust, a nonprofit organization in Washington, characterized the switch as “out of the frying pan and into the fire.”

But Michael Herndon, a spokesman for the Food and Drug Administration, said the government is “not now planning any regulatory action.” In 2002 his agency cautioned that “developing males” should avoid exposure to the DEHP in vinyl used in medical devices.

When it comes to food preparation, Mr. Herndon wrote in an e-mail message, DEHP dissolves in oil, “but is not easily soluble in water,” so it should be used in gloves “that are intended to contact foods of high water content only.” He did not elaborate on how restaurants were to follow that advice.

Allen Blakey, a spokesman for the Vinyl Institute, a trade group based in Arlington, Va., said: “We have seen no evidence that vinyl gloves are unsafe. The Consumer Product Safety Commission has reviewed the safety of vinyl toys, and the F.D.A. has reviewed the safety of vinyl medical devices, and both agencies have found little to no concern with the vast majority of vinyl products they’ve reviewed. I think that probably says a lot about the safety of vinyl gloves.”

The practice of using gloves in restaurants was intended to cut down on food-borne illnesses, which sicken tens of millions of Americans a year, according to the Centers for Disease Control and Prevention. Some of those illnesses are transmitted by workers’ hands. Under New York State law, food workers must use gloves, utensils or paper when touching ready-to-eat foods. Most states have similar guidelines.

Rhode Island was the first state to ban latex gloves from restaurants, in 1999; Arizona followed in 2001, Oregon in 2003. The states acted as a result of increases in consumer complaints and in workers’ compensation claims stemming from latex-related allergies. About a dozen states are considering or have considered such legislation.

“I’d be thrilled to see fewer gloves, more washing,” said Sue Lockwood, the executive director of the American Latex Allergy Association in Slinger, Wis., who said latex allergies affect about one percent of Americans. Some sufferers try to avoid restaurants where latex is used, she said, but it is often difficult for them to get accurate information from restaurant employees. One way to be sure, she said, “is to ask to have a manager read the box” the gloves come in.

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Adam T. Bradley, who represents parts of Westchester in the New York State Assembly, introduced a bill in January that would require restaurants to post warning signs if they use latex gloves. Mr. Bradley said a constituent told him about his grandson, who has a severe latex allergy. “The first step is to warn people who may be in danger,” Mr. Bradley said.

Such regulations are opposed by the Malaysian Rubber Glove Manufacturers’ Association. (Malaysian companies make most of the gloves used in this country.) Its representatives in Washington say the anti-latex claims are exaggerated. In 2003 it began what it called a public relations offensive that included pointing out that allergic reactions to latex are rare and claiming that vinyl gloves posed other problems.

Bare-hand contact with ready-to-eat food can be safe, said Dr. Donna M. Garren, the vice president for health and safety regulatory affairs for the National Restaurant Association, which represents restaurant owners and opposes mandatory glove rules. But it is safe only if employee hand-washing is carefully monitored. Some health experts agreed that regular washing would be more effective than glove use.

“The reason that workers wear gloves is that they don’t wash their hands as much as they should,” said Denise Korniewicz, a professor at the University of Miami School of Nursing and Health Studies who has studied the efficacy of rubber gloves for more than 20 years. “If you walk into any fast-food restaurant and observe people, they use the cash register, they wipe their nose and then they make your sandwich.”

Some restaurant owners are not sure the gloves make anybody safer.

“When your hands are bare you can tell if you get something on them, and you immediately wash,” said Debra Silva, who owns Clem & Ursie’s, a seafood restaurant in Provincetown, Mass. “But if you’re wearing gloves, you might have no idea that you’ve touched something dirty.”

Ms. Silva said she spends thousands of dollars a year on gloves. “I go through a case or two a week,” she said. Each case contains 100 gloves.

Many sushi chefs prepare raw fish with their bare fingers despite the rules requiring them to use gloves, tongs or paper. On a recent night the chefs at a Greenwich Village sushi bar scoffed at the idea of using gloves. One, who did not want to give his name for fear of getting the restaurant in trouble, said gloves would make it difficult to tell, by feel, if the fish was fresh. In that way, he said, gloves could make customers less safe. “You can’t make real sushi with gloves on,” he said.

It was the same story at a sushi restaurant in Midtown. “We’ve been doing it this way for 250 years,” one chef said. “People who make the regulations just don’t understand.”

AFPA April 2007 Health & Fitness Online Newslettervol. 12 no. 4When you wish to instruct, be brief; that men's minds take in quickly what you say, learn its lesson, and retain it faithfully. Every word that is unnecessary only pours over the side of a brimming mind. - Cicero (106 BC - 43 BC)

God Does Answer Your PrayersAccording to a new, comprehensive analysis of 17 major studies on the effects of intercessory prayer -- prayer that is offered for the benefit of another person -- there is a positive effect for people with both medical and psychological problems.Some individual studies have found positive results, while others have shown no effect. A meta-analysis of all studies allowed researchers to take into account the entire body of research.When the effects of prayer were averaged across all 17 studies, controlling for differences in sample sizes, there was a net positive effect on the group being prayed for.Research on Social Work Practice, Vol. 17, No. 2, March 2007: 174-187Science Blog March 14, 2007

Cancer Rates Continue to WorsenAmerica's aging population will increase the number of cancer patients 55 percent by 2020, and doctors may not be able to cope with the additional burden.Today, 11.7 million people, or one in 26, have been diagnosed with the illness.Analyses predict that the number of Americans who are diagnosed with cancer will grow to 18.2 million by 2020, about one in 19 Americans. There may not be enough doctors to care for so many sick people; if current trends continue, the country could face a shortage of up to 4,000 cancer specialists.Increases in cancer have paralleled the increase in the number of Americans over 65. The country can also expect to see increases in heart disease, diabetes and Alzheimer's disease as the population ages.Journal of Oncology Practice, Vol. 3, No. 2, March 2007: 79-86USA Today March 14, 2007The following are some excellent recommendations:Control your insulin levels: Make certain that you limit your intake of processed foods and sugars as much as possible. Get appropriate amounts of animal-based omega-3 fats and make sure you use cod liver oil if you don't have regular access to sun exposure. Get appropriate exercise. One of the primary reasons exercise works is that it drives your insulin levels down. Controlling insulin levels is one of the most powerful ways to reduce your cancer risks. Normalize your vitamin D levels with safe amounts of sun exposure (addressed in my video). This works primarily by optimizing your vitamin D level. If you have regular access to sun exposure then you should use fish oil, not cod liver oil, as your primary source of omega-3 fats. Ideally, it would be best to monitor your vitamin D levels. Have a tool to permanently erase the neurological short-circuiting that can activate cancer genes. Even the CDC states that 85 percent of disease is caused by emotions. It is likely that this factor may be more important than all the other physical ones listed here, so make sure this is addressed. Energy psychology seems to be one of the best approaches and my particular favorite tool, as you may know, is the Emotional Freedom Technique. Only 25 percent of people eat enough vegetables, so by all means eat as many vegetables as you are comfortable with. Ideally, they should be fresh and organic. However, please understand that, frequently, fresh conventionally grown vegetables are healthier than organic ones that are older and wilted in the grocery store. They are certainly better than no vegetables at all, so don't use that as an excuse. Make sure you are not in the two-thirds of the population who are overweight and maintain an ideal body weight. Get enough high-quality sleep. Reduce your exposure to environmental toxins like pesticides, household chemical cleaners, synthetic air fresheners and air pollution. Boil, poach or steam your foods, rather than frying or charbroiling them.

Are You Eating Enough Fruits and Vegetables?According to the U.S. Centers for Disease Control and Prevention, fewer than a third of American adults eat the amount of fruits and vegetables recommended by the government.This trend has remained steady for more than a decade, and is well below the benchmark for the national goal of getting the majority of Americans to eat two servings of fruits and three servings of vegetables each day by 2010.The information comes from a massive diet survey of more than 300,000 adults in 2005. It showed that only 27 percent of adults ate vegetables three times a day, and only about 33 percent ate fruit twice a day.Senior citizens were more likely to eat more fruits and vegetables. Adults aged 18 to 24 ate the fewest vegetables, and those aged 35 to 44 ate the least fruit.Morbidity and Mortality Weekly Report, Vol. 56, No. 10, March 16, 2007: 213-217 Free Full-Text ReportSan Francisco Chronicle March 15, 2007

Calcium Supplements Fail to Improve Children's Bone HealthA new analysis shows little benefit to using calcium supplements to improve bone health in children. Nineteen randomized controlled trials were reviewed to determine the effectiveness of calcium supplementation for improving bone mineral density in children. Supplementation had no effect on the bone mineral density in the neck or spine and caused only a small increase in the density of the upper limb, equivalent to a 1.7 percentage increase in the supplemented group compared with the control. No lasting effect of supplementation was seen in the one study that reported total body density after supplementation stopped.Winzenberg T, Shaw K, Fryer J, Jones G. Effects of calcium supplementation on bone density in healthy children: meta-analysis of randomized controlled trials. BMJ. 2006;333:775

By GINA KOLATAKeith Orr thought he would surprise his doctor when he came for a checkup.

His doctor had told him to have a weight-loss operation to reduce the amount of food his stomach could hold, worried because Mr. Orr, at 6 feet 2 inches, weighed 278 pounds. He also had a blood sugar level so high he was on the verge of diabetes and a strong family history of early death from heart attacks. And Mr. Orr, who is 44, had already had a heart attack in 1998 when he was 35.

But Mr. Orr had a secret plan. He had been quietly dieting and exercising for four months and lost 45 pounds. He envisioned himself proudly telling his doctor what he had done, sure his tests would show a huge drop in his blood sugar and cholesterol levels. He planned to confess that he had also stopped taking all of his prescription drugs for heart disease.

After all, he reasoned, with his improved diet and exercise, he no longer needed the drugs. And, anyway, he had never taken his medications regularly, so stopping altogether would not make much difference, he decided.

But the surprise was not what Mr. Orr had anticipated. On Feb. 6, one week before the appointment with his doctor, Mr. Orr was working out at a gym near his home in Boston when he felt a tightness in his chest. It was the start of a massive heart attack, with the sort of blockage in an artery that doctors call the widow-maker.

He survived, miraculously, with little or no damage to his heart. But his story illustrates the reasons that heart disease still kills more Americans than any other disease, as it has for nearly a century.

Medical research has revealed enough about the causes and prevention of heart attacks that they could be nearly eliminated. Yet nearly 16 million Americans are living with coronary heart disease, and nearly half a million die from it each year.

It's not that prevention doesn't work, and it's not that once someone has a heart attack there is little to be done. In fact, said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute at the National Institutes of Health, age-adjusted death rates for heart disease dropped precipitously in the past few decades, and prevention and better treatment are major reasons why.

But the concern, Dr. Nabel and others say, is that much more could be done. In many ways, scientists' hard-won and increasingly detailed understanding of what causes heart disease and what to do for it often goes unknown or ignored.

Studies reveal, for example, that people have only about an hour to get their arteries open during a heart attack if they are to avoid permanent heart damage. Yet, recent surveys find, fewer than 10 percent get to a hospital that fast, sometimes because they are reluctant to acknowledge what is happening. And most who reach the hospital quickly do not receive the optimal treatment - many American hospitals are not fully equipped to provide it but are reluctant to give up heart patients because they are so profitable.

And new studies reveal that even though drugs can protect people who already had a heart attack from having another, many patients get the wrong doses and most, Mr. Orr included, stop taking the drugs in a matter of months. They should take the drugs for the rest of their lives.

"We've done pretty well," Dr. Nabel said. "But we could be doing much better. I've heard some people refer to it as the rule of halves. Half the people who need to be treated are treated and half who are treated are adequately treated."

The result, heart researchers say, is a huge disconnect between what is possible and what is actually happening.

Crucial Miscalculations

Keith Orr's story has themes that resonate with every cardiologist. He did many things right, but also made some crucial miscalculations that were so common that nearly every patient makes them, cardiologists say. But not everyone comes out as well.

Mr. Orr anticipated a pleasant day on Feb. 6, starting with a workout at his gym, then lunch with a friend before he went to work at Smith & Wollensky, a steakhouse where he is a manager.

He arrived at the gym around noon and lifted weights, concentrating on the pectoral muscles of his chest. Then he moved on to an elliptical cross-trainer for cardiovascular exercise.

After half an hour on the elliptical, Mr. Orr felt a tightness in his chest. "I attributed it to the weight training," he said, but stopped exercising, showered, dressed and walked to his car.

"I felt really bad, out of sorts," he said. The pressure in his chest would ease off and then intensify, and now he was sweating profusely and was nauseated. When he arrived at the restaurant, he told his friend Darrin Friedman that he would have to beg off from lunch. "I feel like hell," he told Mr. Friedman.

He went home and lay on his bed.

"I knew at that point that it was not a pulled muscle," Mr. Orr said. "It's a completely different feeling of pressure and discomfort. You feel as though something is genuinely wrong."

It was 3:15. And the pain was no longer intermittent. It was constant.

Mr. Orr called Mr. Friedman and asked him to drive him to an emergency room. A few minutes later, the two set off for Brigham and Women's Hospital, about a 10-minute drive.

"Keith was hunched over and he didn't put his seat belt on," Mr. Friedman said. "I kept asking him, 'Is it getting better or getting worse or staying the same?' For the first 10 minutes he said, 'It's about the same.' Then, when we were a block or so away, he said: 'I'm not doing well. I think it's getting worse.' "

When they arrived at the hospital's emergency department, Mr. Friedman explained that his friend was having chest pains. Immediately, Mr. Orr was wheeled off for an electrocardiogram, showing his heart's electrical signals. It was ominous, including one pattern called the tombstone T wave because patients who had it died in the days before there were aggressive treatments to open arteries.

The next thing Mr. Orr knew, he was being rushed to the cardiac catheterization laboratory for a procedure to open his artery.

The electrocardiogram was at 3:45 p.m., roughly 30 minutes after his symptoms changed from intermittent to constant and 5 minutes after he got to the hospital.

At 3:52 p.m., Dr. Ashvin Pande, a cardiology fellow, was chatting in the hallway when he was called to the catheterization lab.

"Big M.I. coming in," a nurse told Dr. Pande, using the abbreviation for myocardial infarction, or heart attack. At the time, the room was occupied - a patient was lying on the table for an elective procedure. He was quickly wheeled out and Mr. Orr was wheeled in. It was 3:56 p.m.

Within minutes, Dr. James M. Kirshenbaum, director of acute interventional cardiology, assisted by Dr. Pande, threaded a thin tube, like a long and narrow straw, from an artery in Mr. Orr's groin to his heart. They injected a dye to make Mr. Orr's arteries visible to an X-ray and they saw the problem - a huge clot in his heart's left anterior descending artery, blocking blood flow to most of his heart.

The quickest option was to open that artery with a balloon and keep it open with a stent, a tiny mesh cage, if possible.

It worked - the balloon shattered the clot and pushed the debris against the artery wall and the stent held the artery open. Then a different problem arose. When the large clot was pushed aside, the debris was shoved against the opening of a small artery that branched from the larger one, much as a snowplow clearing a street can block a driveway.

"We made a calculated decision that it would be worth sacrificing the branch to secure the main vessel," Dr. Pande said. But, fortunately, they were able to insert another balloon through the stent and into the small artery, opening it too.

At 4:43, the procedure was over and Mr. Orr was wheeled to the coronary intensive care unit. He had been awake but sedated and experienced what he said was the amazing feeling of having his artery opened. "As soon as the balloon goes in, all the pain disappears," he said. "You know immediately."

The cardiologists who saved his life walked out of the room, grinning and exhilarated.

Mr. Orr was incredibly lucky, said Dr. Elliott Antman, director of the coronary care unit at Brigham and Women's Hospital. He ended up with little or no damage to his heart, even though he teetered between lifesaving decisions and critical miscalculations in his moments of crisis.

The first lifesaving decision was to go to a hospital soon after his chest pain began. But the miscalculation was to call his friend for a ride. He should have called an ambulance.

Had his friend gotten caught in traffic, Mr. Orr might have been dead or sustained serious injury to his heart. He might have had to go to a rehabilitation center and learn special tactics for conserving energy, like sliding a coffeepot along a counter instead of lifting it.

What few patients realize, Dr. Antman said, is that a serious heart attack is as much of an emergency as being shot.

"We deal with it as if it is a gunshot wound to the heart," Dr. Antman said.

Cardiologists call it the golden hour, that window of time when they have a chance to save most of the heart muscle when an artery is blocked.

But that urgency, cardiologists say, has been one of the most difficult messages to get across, in part because people often deny or fail to appreciate the symptoms of a heart attack. The popular image of a heart attack is all wrong.

"That's the man clutching his chest, grimacing in pain and going down," Dr. Peterson said. "That's what people imagine a heart attack is like. What they don't imagine is that it's not so much pain as pressure, a feeling of heaviness, shortness of breath."

Most patients describe something like Mr. Orr's symptoms - discomfort in the chest that may, or may not, radiate into the arms or neck, the back, the jaw, or the stomach. Many also have nausea or shortness of breath. Or they break out in a cold sweat, or have a feeling of anxiety or impending doom, or have blue lips or hands or feet, or feel a sudden exhaustion.

But symptoms often are less distinctive in elderly patients, especially women. Their only sign may be a sudden feeling of exhaustion just walking across a room. Some say they broke out in a sweat. Afterward, they may recall a feeling of pressure in their chest or pain radiating from their chest but at the time, they say, they paid little attention.

Patients with diabetes might have no obvious symptoms at all other than sudden, extreme fatigue. It's not clear why diabetics often have these so-called silent heart attacks - one hypothesis attributes it to damage diabetes can cause to nerves that carry pain signals.

"I say to patients, 'Be alert to the possibility that you may be short of breath,' " Dr. Antman said. "Every day you walk down your driveway to go to your mailbox. If you discover one day that you can only walk halfway there, you are so fatigued that you can't walk another foot, I want to hear about that. You might be having a heart attack."

Other times, said Dr. George Sopko, a cardiologist at the National Heart, Lung and Blood Institute, symptoms like pressure in the chest come and go. That is because a blood clot blocking an artery is breaking up a bit, reforming, breaking and reforming. It was what happened to Mr. Orr when he was at the gym and meeting his friend afterward.

"It's a pre-heart attack," Dr. Sopko said. A blood vessel is on its way to being completely blocked. "You need to call 911."

But most people - often hoping it is not a heart attack, wondering if their symptoms will fade, not wanting to be alarmist - hesitate far too long before calling for help.

"The single biggest delay is from the onset of symptoms and calling 911," said Dr. Bernard Gersh, a cardiologist at the Mayo Clinic. "The average time is 111 minutes, and it hasn't changed in 10 years."

'Time Is Muscle'

At least half of all patients never call an ambulance. Instead, in the throes of a heart attack, they drive themselves to the emergency room or are driven there by a friend or family member. Or they take a taxi. Or they walk.

Patients often say they were embarrassed by the thought of an ambulance arriving at their door.

"Calling 911 seems like such a project," Mr. Orr said. "I reserve it for car accidents and exploding appliances. I feel like if I can walk and talk and breathe I should just get here."

It is an understandable response, but one that can be fatal, cardiologists say.

"If you come to the hospital unannounced or if you drive yourself there, you're burning time," Dr. Antman said. "And time is muscle," he added, meaning that heart muscle is dying as the minutes tick away.

There may be false alarms, Dr. Sopko said.

"But it is better to be checked out and find out it's not a problem than to have a problem and not have the therapy," he said.

Calling an ambulance promptly is only part of the issue, heart researchers say. There also is the question of how, or even whether, the patient gets either of two types of treatment to open the blocked arteries, known as reperfusion therapy.

One is to open arteries with a clot-dissolving drug like tPA, for tissue plasminogen activator.

"These have been breakthrough therapies," said Dr. Joseph P. Ornato, a cardiologist and emergency medicine specialist who is medical director for the City of Richmond, Va. "But the hooker is that even the best of the clot buster drugs typically only open up 60 to 70 percent of blocked arteries - nowhere close to 100 percent."

The drugs also make patients vulnerable to bleeding, Dr. Ornato said.

One in 200 patients bleeds into the brain, having a stroke from the treatment meant to save the heart.

The other way is with angioplasty, the procedure Mr. Orr got. Cardiologists say it is the preferred method under ideal circumstances.

Stents have recently been questioned for those who are just having symptoms like shortness of breath. In those cases, drugs often work as well as stents. But during a heart attack or in the early hours afterward, stents are the best way to open arteries and prevent damage. That, though, requires a cardiac catheterization laboratory, practiced doctors and staff on call 24 hours a day. The result is that few get this treatment.

"We now are seeing really phenomenal results in experienced hands," Dr. Ornato said. "We can open 95 to 96 percent of arteries, and bleeding in the brain is virtually unheard of. It's a safer route if it is done by very experienced people and if it is done promptly. Those are big ifs."

The ifs were not a problem for Mr. Orr. His decision to go to Brigham and Women's Hospital proved exactly right. But he did not know that when he chose the hospital - he chose it because his doctor was affiliated with Brigham.

A Need for More Angioplasty

Currently, 30 percent of patients who are candidates for reperfusion do not receive it, and of those who do, only 18 percent are treated with angioplasty, said Dr. Alice Jacobs, director of the cardiac catheterization laboratory at Boston University School of Medicine and a past president of the American Heart Association. Of the nation's 5,000 acute care hospitals, Dr. Jacobs said, only 1,200 provide angioplasty.

Most hospitals, she said, cannot offer angioplasty because they do not have enough patients for a team of doctors to maintain their skills. An obvious solution would be to make heart attack care more like trauma care - sending patients to the nearest hospital that can provide angioplasty as quickly as possible. But that is not always easy, Dr. Jacobs said, because hospitals do not want to lose cardiac patients.

A major reason, she said, is financial. Hospitals are reimbursed by Medicare according an index that measures the acuity of medical conditions they treat.

It is also difficult for patients who live in rural areas, where community hospitals are too small to offer angioplasty and larger hospitals that do offer it are hours away. Minnesota is experimenting with a program using helicopters to transport patients quickly. But for most rural patients elsewhere, angioplasty is almost an impossibility.

Dr. Antman suggests that heart disease patients ask their doctor if there is a hospital nearby that does angioplasty around the clock. If so, they might want to discuss with their doctor whether to ask that an ambulance take them there if they are having a heart attack.

It is the sort of advice that makes cardiologists nervous - they do not want to encourage patients to dictate treatment. But, Dr. Antman said, if it is feasible to get to an angioplasty-providing hospital within an hour, "in most cases that would be preferable."

Getting the Proper Therapy

Opening an artery is only the start of treatment. The next part is at least as problematic: Patients have to get the right drugs, in the right doses, and have to take them for the rest of their lives.

"Care is getting a lot better," Dr. Peterson said. "But the only caveat is that they are only really looking at, Did you get therapy? No one is looking too closely at, Did you do it right?"

For example, he said, a recent study found that heart attack patients were getting blood-thinning prescription drugs to prevent clots, as they should, but up to 40 percent were getting the wrong dose, usually one too high.

And even if every prescription were exactly right, as many as half of all patients do just what Mr. Orr did after his first heart attack. They stop taking many or all of their drugs.

Sometimes it is a matter of communication.

"The information did not get to the primary doctor and the primary doctor did not know to renew the prescription," Dr. Peterson said. "When we talk to patients, they say: 'No one communicated to me the importance of being on the medications long term. I thought I would only need them for three months, I thought it would be like an antibiotic. I thought they put in a stent so why do I need a drug?' "

But there may be more to it than ignorance. There also is the image those pills convey of a sick person.

Mr. Orr said he did not like to think of himself as someone who had to take a fistful of pills every day. Even the recommended daily aspirin seemed superfluous, he thought.

"I think I sort of pooh-poohed the notion that one tablet of aspirin each day would do anything," Mr. Orr said.

What it does is make blood less likely to clot. In Mr. Orr's case, Dr. Antman said, it is likely that when Mr. Orr was exercising on the cross-trainer, an area of plaque ruptured. Then a clot began to form in the area, eventually blocking the artery.

The problem was not exercise, which is good for people with heart disease, but Mr. Orr's decision not to take his medications, Dr. Antman said. If he had been taking aspirin that clot would have had more difficulty forming and growing.

Dr. Antman has a message for patients: With a disease as serious as heart disease, those who take responsibility are often the ones who survive.

Having a heart attack, even if it turns out well, as his did, is a life-altering experience, Mr. Orr said.

His first heart attack, Mr. Orr said, "came out of the blue." When he was discharged from the hospital, he was terrified that it would happen again when he was alone and unable to call for help. "I had a really hard time with it," he said. "I only stayed in my own house for one night and then I moved to a friend's house for two weeks."

Now Mr. Orr plans to be serious about taking his medication and getting back to his diet and exercise program. He will call an ambulance if he ever has symptoms again. Still, he hates to think of himself as a patient. "I'm a little freaked out that I will have to take medication for the foreseeable eternity," Mr. Orr said.

But the day after he got home from the hospital, he thought about what had happened.

"The gravity of the situation just sort of clicked," Mr. Orr said. "I started to cry."

By David BrownWashington Post Staff WriterThursday, April 26, 2007; A03

An experimental blood test for prostate cancer may help eliminate tens of thousands of unnecessary biopsies at the same time that it detects many tumors that are now missed by the test commonly used, its developers said yesterday.

PSA, the current test, measures a protein normally produced by the prostate, while the experimental one, called EPCA-2, detects a chemical made principally in cancerous tissue.

Prostate cancer, the most common malignancy in men, is one of the more perplexing areas of medicine. Physicians are unsure how to find it and when to treat it.

Today, about 80 percent of prostate biopsies find no tumor -- a percentage that is rising as physicians become more aggressive in searching for the disease.

"We hope this will minimize the number of unnecessary biopsies," said Robert H. Getzenberg, a molecular biologist at Johns Hopkins Hospital who developed the new test, which is still under study and not yet commercially available. A description of it appears today in the journal Urology.

"It's an exciting new marker," said Martin G. Sanda, a urologist at Harvard Medical School. "There certainly is a need for a better test than PSA. Everyone accepts that." His view was echoed by Gerald L. Andriole Jr., chief of urologic surgery at Washington University School of Medicine, who said that "if the data hold up, this marker will be a substantial improvement over PSA."

The PSA test casts a net that is too big and too full of holes. Finding a replacement that catches fewer healthy men, but more of those who do have cancer, would help settle at least one of the clinical conundrums concerning prostate cancer.

The new test is being developed by researchers at Johns Hopkins Hospital and Onconome Inc., a Seattle-based biomedical company. It could become commercially available in 2008.

Prostate cancer is diagnosed in about 230,000 American men each year, and about 30,000 die of it. The death rate is 2.5 times higher among blacks than among whites.

At the moment, men are screened for the disease in two ways -- by a rectal exam and by the PSA (prostate-specific antigen) test. If a lump is detected or if the PSA is above 2.5 (nanograms per milliliter of plasma), most physicians will suggest a biopsy.

EPCA-2 is a protein that is part of the "nuclear matrix," the scaffolding inside a cell's nucleus that helps it copy its genes. The Hopkins researchers measured it in different groups of men whose cancer status was known.

They tried the new test on 30 men with PSA readings above 2.5 and in whom biopsies found no cancer. All had normal EPCA-2 readings (below 30 ng per ml.). This suggested that the test may eliminate many of the "false-positive" PSA results -- readings that are abnormal but apparently do not denote cancer.

On the other hand, the EPCA-2 test appears able to detect cancer even when the tumor is small. It identified 36 out of 40 men who had cancer confined to the prostate gland, and 39 out of 40 men in whom the tumor had spread. It also identified many men -- 14 out of 18 -- who had cancer but whose PSAs were normal.

This last group is especially worrisome to physicians. A study published three years ago found that about 12 percent of men with normal PSA readings have cancer.

The new test is not perfect, though. Getzenberg and his colleagues tried it on 35 men with severe "benign prostatic hypertrophy" -- enlargement of the prostate that sometimes makes the PSA go up but is not cancer. In eight of them, the EPCA-2 was high, suggesting that the EPCA-2 test would flag some men who turn out not to have cancer -- although probably not as many as the PSA test does.

The new test will not help solve the other major clinical uncertainty in prostate cancer. It is unclear who will clearly benefit from aggressive treatment and who are likely to be able to live a normal life if the tumors are simply followed and removed only if they begin to cause symptoms.

Remedies: Dark Chocolate Similar to Blood Pressure Drugs By NICHOLAS BAKALARPublished: April 24, 2007NY Times

Eating dark chocolate may be almost as effective at lowering blood pressure as taking the most common antihypertensive drugs, a review of studies has found. Tea, on the other hand, appears to be ineffective.

Effect of Cocoa and Tea Intake on Blood Pressure (Archives of Internal Medicine)The article says a diet rich in fruits and vegetables is healthy partly because plants contain chemical substances called polyphenols that help control blood pressure. In Western countries, the major sources of dietary polyphenols are tea and chocolate, but studies of their ties to blood pressure have had mixed results.

From more than 3,000 papers, researchers picked the largest randomized and controlled prospective studies and used statistical techniques to combine the data. The analysis included four studies of black tea, one of green tea and five of dark chocolate. It appears in the April 9 issue of The Archives of Internal Medicine.

Four of the five studies on chocolate found reduced blood pressure after eating, but none of the tea studies showed significant benefit. The magnitude of the effect of eating three and a half ounces of dark chocolate a day was clinically significant, comparable to that of beta-blockers like atenolol, known by the brand name Tenormin, or propranolol, known as Inderal. The authors acknowledge that the studies were short and that results may not apply to habitual use.

Milk proteins prevent the absorption of polyphenols, so milk chocolate is not effective. “I’ve been eating a little more dark chocolate,” said Dr. Dirk Taubert, the lead author and a professor of pharmacology at University Hospital in Cologne, Germany. “And my blood pressure has gone down. But I have no dietary recommendations for others.”

ATLANTA - A vegan couple were sentenced Wednesday to life in prison for the death of their malnourished 6-week-old baby boy, who was fed a diet largely consisting of soy milk and apple juice.

Superior Court Judge L.A. McConnell imposed the mandatory sentences on Jade Sanders, 27, and Lamont Thomas, 31. Their son, Crown Shakur, weighed just 3 1/2 pounds when he died of starvation on April 25, 2004.The couple were found guilty May 2 of malice murder, felony murder, involuntary manslaughter and cruelty to children. A jury deliberated about seven hours before returning the guilty verdicts.

Defense lawyers said the first-time parents did the best they could while adhering to the lifestyle of vegans, who typically use no animal products. They said Sanders and Thomas did not realize the baby, who was born at home, was in danger until minutes before he died.

But prosecutors said the couple intentionally neglected their child and refused to take him to the doctor even as the baby’s body wasted away.“No matter how many times they want to say, ‘We’re vegans, we’re vegetarians,’ that’s not the issue in this case,” said prosecutor Chuck Boring. “The child died because he was not fed. Period.”

Although the life sentences were automatic, Sanders and Thomas begged for leniency before sentencing. Sanders urged the judge to look past his “perception” of the couple.

“I loved my son — and I did not starve him,” she said.When the judge told the defendants they could ask for a new trial, Thomas hung his head low.

“I’m dying every day in there,” he said, “and that could take three years.” ======================

"A DEFICIENCY IN JUST ONE nutrient--vitamin B12--can halt the development of a baby's brain. The Centers for Disease Control (CDC) recently reported two cases of severe BI2 deficiency in toddlers who were breast-fed by vegan mothers. Vegans practice a strict form of vegetarianism, cutting all meat from their diet, as well as eggs, dairy and other animal by-products. The vitamin occurs naturally only in animal products and helps maintain nerve and blood cells.The two mothers ( ) who both lived in Georgia, were themselves deficient in B12. Although both morns said they intermittently took vitamin supplements, the deficiency caused developmental delays in the children, who were 15 months old and two and a half years old at the time of the study. Both had about half the language and motor skills of average kids their age. The rate of B12 deficiency in the general population is unknown, according to the CDC."

It takes time and thought to feed infants and children, and all parents, should think carefully about what their children eat. The years from birth to adolescence are when eating habits are set, when growth rates are high, and to a large extent when the size of stores of essential nutrients such as calcium are determined. This article will examine the health benefits of vegan diets for children, address potential concerns, present information on key nutrients and provide guidelines for feeding vegan infants and children.

The number of vegans in the UK today is estimated at 0.5%(1) but we do not know how many of these are children. In the US, a poll commissioned by the Vegetarian Resource Group in the year 2000 found that about 0.5% of 6 to 17-year-olds were vegan and did not eat meat, fish, poultry, dairy products or eggs (2).

Health Benefits of Vegan Diets

Several studies have examined the nutrient intakes of vegan children. One study of British school-age children found that they had higher intakes of fibre and that intakes of all vitamins and minerals studied (with the exception of calcium) were comparable with those of meat-eating children(3). Vegan pre-schoolers in the US were found to have generous intakes of protein, vitamins, and minerals and their diets exceeded recommended intakes for all nutrients studied with the exception of calcium (4).

The study showing lower calcium intakes by vegan pre-schoolers was conducted before calcium-fortified products were readily available, so calcium intakes of vegan children may be higher now. Calcium is important for bone development. Around 45% of adult bone mass is accrued before 8 years of age, another 45% is added between 8-16 years of age and a further 10% accumulates in the next decade. Given the importance of calcium intake during childhood, all parents should ensure that their children's diets contain calcium-rich foods and meet current recommendations for calcium for their age group.

Regrettably, there have been few recent studies looking at the long-term effects of a vegan diet*, especially as it is believed that the foundations for many chronic diseases of adulthood have their beginnings in childhood. For instance, processes initiating atherosclerosis and high blood pressure are thought to start very early in life, and blood pressure and cholesterol levels have been shown to track from early childhood and to be related to childhood nutrient intakes(5,6). Body mass also tracks from early childhood, with obese children being at an increased risk of obesity in adulthood(7)

When we look at potential long-term health benefits of vegan diets, we find that vegan children have higher intakes of fruits and vegetables, foods that are important for health. Vegan children have been shown to have lower intakes of fat, saturated fat, and cholesterol than non-vegetarian children(9-10). This may be important in reducing the risk of developing chronic diseases such as heart disease and obesity. Finally, vegan diets may introduce children to a greater variety of whole plant foods, thus establishing healthful lifelong eating habits.

Vegan Infants

Up to the age of four to six months, the diets of many infants of vegan and of non-vegan parents are identical. The perfect food for the young infant is breast milk and supplementary foods should not be introduced until after four to six months of age. Breast-fed infants of well nourished vegan women tend to grow and develop normally(11). The infant receives many benefits from breast feeding, including some immune system enhancement, protection against infection, and reduced risk of allergies(12). Moreover, as human breast milk is the natural food for baby humans it also probably contains substances needed by growing infants which are not even known to be essential and are not included in infant formulas. Meanwhile, nursing mothers derive benefits such as reduced risk of premenopausal breast cancer, release of stress-relieving hormones and, for some, sheer convenience(12). For all these reasons, we strongly encourage breast feeding.

Vitamin B12 and vitamin D are key nutrients for a young infant being exclusively breast fed by a vegan woman. Mothers whose diets contain little or no vitamin B12 will produce milk with very low levels of vitamin B12(13). As this vitamin is important for the developing nervous system, it is crucial for the infant to have a reliable source of vitamin B12. Some vegan women opt to use a vitamin B12 supplement while others rely on fortified foods such as some breakfast cereals, fortified yeast extracts, non-dairy milks and some soya products in order to meet both their own and their baby's need for vitamin B12. If the mother's diet does not contain a reliable daily source of vitamin B12, the child itself should receive a daily source of vitamin B12.

The vitamin D content of breast milk varies with the mother's diet and her sun exposure, although vitamin D levels in breast milk are usually quite low. All children below three years of age have a high requirement for vitamin D to enable calcium deposition in bone. The Department of Health therefore recommends that vitamin drops containing vitamins A, C and D be used for all children from 6 months to 5 years of age, whether vegan, vegetarian or omnivore. Welfare vitamin drops which are available at low cost, or free to certain families, contain no animal products and are suitable for vegans.

Logged

"You see, it's not the blood you spill that gets you what you want, it's the blood you share. Your family, your friendships, your community, these are the most valuable things a man can have." Before Dishonor - Hatebreed

A continuation from the above article--------------------------------------------------------------

Readers may also have heard of docosahexaenoic acid or DHA, a fatty acid which appears to be important for eye and brain development and is found primarily in animal foods. However, vegans can make DHA from another fatty acid called alpha-linolenic acid, which will be contained in the breast milk if the mother's diet includes good sources such as flaxseed oil, ground flaxseed and rapeseed oil. Reducing the use of other oils such as corn oil, sunflower oil, and safflower oil and limiting foods containing hydrogenated fats will also help the breast fed infant to make more DHA. These oils contain linoleic acid and hydrogenated fats contain trans-fatty acids which interfere with DHA production.If breast feeding is not possible or is contraindicated, there is just one formula feed suitable for vegan infants: Vegan Society trade mark holder Farley's Soya Formula by Heinz. On no account should soya milk, nut milk, rice milk, oat milk, pea milk or other home-prepared "formulas" be used as these do not contain the appropriate ratio of nutrients and can lead to potentially life-threatening conditions.

Introduction of Solid Foods

Solid foods should not be introduced before 4 months of age. Try to introduce one new food at a time, waiting 2 to 3 days before trying another. It is then easier to identify which food is responsible if any untoward reaction occurs.

First weaning foods may include rice based dishes, pureed and sieved fruits such as banana, pear and apple, and vegetables such as carrot, potato and spinach. At 6 months of age, wheat and oat based cereals can be introduced. Foods containing generous amounts of protein such as mashed cooked pulses, mashed tofu and soya yogurt are generally introduced at around 7 to 8 months of age. Children should progress from mashed or pureed foods to pieces of soft food. Smooth nut and seed butters spread on bread or crackers can be introduced after the first birthday. In an atopic family, where there is a history of allergies, peanuts and nuts should be avoided until the child is at least 3 years of age (14) to allow the gut to mature and the immune system to develop fully.

As solid foods become a larger part of the diet, consideration should be given to foods which provide concentrated sources of calories and nutrients. These include mashed firm tofu, bean spreads, mashed avocado and cooked dried fruits. Frequent meals and snacks help to ensure adequate energy intakes. The fat intake of healthy infants should not be restricted, and sources such as vegetable oils or soft vegan margarine should be included in the older infant's diet.

To minimize the risk of choking, foods such as whole nuts, crunchy nut butters, vegan hot dogs, large chunks of hard raw fruits and vegetables, whole grapes, hard sweets, and popcorn should not be fed to infants and children younger than 3. However, chopping the nuts, slicing the hot dogs and halving the grapes can reduce the risk and allow such foods to be eaten by toddlers age 1-3 years. Corn syrup and honey (the latter is always avoided by vegans in the UK anyway) should not be given to infants younger than one year because of the risk of botulism, a form of food poisoning.

A note on nuts. The American Academy of Pediatrics does not recommend any sort of nut butters for children under 3 years. In families where there is a history of allergy, eczema or asthma, it is recommended that peanuts and peanut products be delayed until the child is at least 3 years old. Other children may have peanuts and tree nuts of a suitable texture, such as smooth nut butter, from the age of 6 months or when weaned, but not before 4 months. In the UK, it is recommended that peanuts be avoided by pregnant or breastfeeding women if there is a history of allergies. It is suggested that women who are atopic, or where the father or any sibling has atopic disease, may wish to avoid peanuts in their diet to reduce the risk of their children developing peanut allergy, but this is simply precautionary as there has been no conclusive evidence.

Many parents choose to use commercially prepared baby foods and there are some product suitable for vegan infants, though careful label reading is recommended. As there is only a limited selection of commercial products for the older vegan infant, many parents opt to prepare their own baby foods. Foods should be well washed, cooked thoroughly and blended or mashed to an appropriate consistency. Home prepared foods can be kept in the refrigerator for up to 2 days or frozen in small quantities for later use.

By 6 months of age, iron stores in omnivorous, vegetarian and vegan infants will become depleted and it is important that iron-rich foods are included in the diet. Iron-fortified infant cereals are a good way to supply iron to vegan infants Other good sources include whole grains, pulses, green leafy vegetables and dried fruits. To enhance iron absorption, add a source of vitamin C such as green leafy vegetables, citrus fruits, blackcurrants or orange juice to the meal.

For the non-vegan child, cow's milk is typically introduced around age 1 year. Commercial fortified non-dairy milks can be added to the diet of vegan toddlers around the same age provided that the child is growing normally, has an appropriate weight and height for age, and is eating a variety of foods including soya products, pulses, grains, fruits and vegetables. For children with slower growth who have been weaned from breast milk, ensure that the diet is energy dense by adding some healthful oils such as olive or rapeseed oil or choosing Plamil's fortified non-dairy milk or Farley's Soy Formula; both are Vegan Society trade mark holders and these product are suitable as a primary beverage as they are higher in calories than other fortified non-dairy milks. Choosing unflavoured varieties of non-dairy milk rather than flavours such as vanilla, cocoa, or carob can help to avoid the development of a preference for very sweet beverages by the young child.

Vegan Toddlers and Preschoolers

Toddlers and preschoolers, whether vegan or not, tend to eat less than most parents think they should. This is generally due to a developing sense of independence and a slowing in growth. While nutrient needs are also relatively lower than during infancy, an adequate diet remains important to promote growth and development. These early years are also important for developing healthy eating patterns that can establish a foundation for a healthful adult diet.

One important consideration for young vegan children is the ability to get enough calories. Young children have small stomachs and too much high fibre food may make them feel full before they get all the calories they need. Foods such as avocados, nut and seed butters, dried fruits, and soya products provide a concentrated source of calories. If necessary, the fibre content of the diet can be reduced by giving some refined grain products, fruit juices and peeled fruits and vegetables. Eating more frequent meals, including nutritious snacks, can also help to ensure adequate energy intakes.

Growth of Vegan Children

If a child's diet contains enough calories, normal growth and development can be expected and studies of vegan children have shown that their caloric intake is close to recommended levels and similar to intakes of non-vegan children of the same age(16,17).

Vegan children in the UK and the US have been found to be slightly shorter and lighter in weight than average but appeared to be growing at a normal rate(15,16). Children need a lot of energy in relation to their size and although healthy eating should be encouraged it is important that the diet be energy dense. Including foods such as vegetable oils, avocados, seeds, nut butters and pulses can provide both calories and nutrients. Dried fruits are also a concentrated source of energy and are an attractive food for many children. Children from an early age should be encouraged to brush teeth after eating dried fruits and other sweet foods to prevent tooth decay.

Key Nutrients for Vegan Children

Protein needs can be easily met if children eat a variety of plant foods and have an adequate intake of calories. It is unnecessary to plan and complement amino acids precisely within each meal so long as children eat a variety of foods each day. Sources of protein for vegan children include pulses (peas, beans, lentils, soya), grains (wheat, oats, rice, barley, buckwheat, millet, pasta, bread), nuts, meat substitutes and nut butters.

Calcium is an important nutrient for growing bones and teeth. Good sources include fortified non-dairy milks and juices, calcium-set tofu, baked beans and dark green leafy vegetables low in oxalic acid such as spring greens and kale. Calcium supplementation may be indicated in cases of inadequate dietary intake.

Children regularly exposed to sunlight under appropriate conditions (two to three times per week for about 20-30 minutes on hands and face) appear to have no dietary requirement for vitamin D. Those children who have limited exposure to sunlight or who are dark skinned and have no dietary source of vitamin D require supplements. Only a few foods naturally contain vitamin D (D3, cholecalciferol) and all of these are animal products. Vitamin D3 is usually obtained from lanolin, which is derived from sheep's wool and therefore not acceptable to vegans. Foods fortified with a vegan source of vitamin D (D2, ergocalciferol) include argarine, some non-dairy milks and fortified breakfast cereals.

Iron deficiency anemia is the most common childhood nutritional problem and is no more likely to occur in vegan than om non-vegan children(. Good sources of iron include whole or enriched grains and grain products, iron-fortified cereals, legumes, green leafy vegetables and dried fruits. Diets of vegan and non-vegan children often contain similar amounts of zinc, though zinc from plant foods is less well absorbed as they contain phytate, which interferes with zinc absorption. Emphasising foods that are good sources of zinc and protein such as pulses and nuts can increase the amount of zinc in the diet and promote absorption. Use of yeast-leavened bread and fermented soya products such as tempeh and miso can also improve zinc absorption(. Zinc supplements may be needed for young vegan children whose diet is based on high-phytate cereals and legumes(19). FSC and Seven Seas produce vegan vitamin and mineral supplements suitable for children.

Vegan children should use foods fortified with vitamin B12 or take vitamin B12 supplements. A variety of foods fortified with vitamin B12 are available, including some brands of vegan milk, meat substitutes, yeast extract and some breakfast cereals. Vegan Society trade mark holders Quest and Vega Nutritionals produce vegan vitamin B12 supplements.

The Transition to a Vegan Diet

Although today more and more children are vegan from birth, many older children also become vegan. There are many ways to make the transition from a non-vegan to a vegan diet. Some families gradually eliminate dairy products and eggs while others make a more abrupt transition. Regardless of which approach you choose, be sure to explain what is going on and why in a way that the child can understand. Offer foods that look familiar at first. Peanut butter sandwiches seem to be universally popular and many children like pasta or baked beans. Gradually introduce new foods. Watch your child's weight closely.

Weight loss is likely at first, but if it continues or the child seems to be growing less rapidly, add more concentrated calories and reduce the amount of fibre in the diet.

Vegan diets planned in accord with current dietary recommendations can meet the nutritional needs of infants and children, give children a better start in life and help to establish lifelong healthy eating patterns.

*Since 1976 Plamil Foods has produced case histories on over 100 children and this is a glowing testimony to veganism.

"You see, it's not the blood you spill that gets you what you want, it's the blood you share. Your family, your friendships, your community, these are the most valuable things a man can have." Before Dishonor - Hatebreed

Plant Sources of Omega-3 Fatty Acids Beneficial to Bone HealthA study at Pennsylvania State University showed that omega-3 fatty acids from plant sources (for example, walnuts and flaxseed) promote bone formation and inhibit bone loss. A randomized crossover study looked at 23 adult participants on three different diets with varying ratios of omega-6 to omega-3 acids. The group with the lowest omega-6-to-omega-3 ratio had significantly lower levels of a biomarker for bone loss compared with the other two groups. Experts often emphasize the ratio (with a smaller ratio being ideal) of omega-6 to omega-3 and not the total consumption of omega-3. Consumption of walnuts and flaxseed has also shown a beneficial effect on risk of cardiovascular disease. Griel AE, Kris-Etherton PM, Hilpert KF, et al. An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J. January 16, 2007;6:2.

Red Meat Linked to Heart Disease in Women with DiabetesA new study finds increased iron intake and red meat consumption add additional risk for heart disease among women with type 2 diabetes. Researchers from the Harvard School of Public Health studied 6,161 women with type 2 diabetes from the Nurses' Health Study. Women with the highest intake of heme iron (iron found mainly in red meats, poultry, and fish) had a 50 percent greater risk of coronary heart disease than those with the lowest intake. Red meat in particular was associated with an increased risk. Adults with diabetes are already at least twice as likely as others to have heart disease or a stroke.Qi L, VanDam RM, Rexrode K, Hu FB. Heme iron from diet as a risk factor for coronary heart disease in women with type 2 diabetes. Diabetes Care. 2007;30:101-106.

Fiber Lowers Breast Cancer RiskA follow-up of the U.K. Women's Cohort Study involving more than 35,000 women found that pre-menopausal women who ate 30 grams of fiber a day had half the risk of breast cancer compared with those who ate less than 20 grams per day. In addition, high protein consumption and low vitamin C intake were associated with increased breast cancer risk among pre-menopausal women. Researchers suspect that since estrogen levels are higher in pre-menopausal women, dietary fiber earlier in life may be more important for regulating female hormones and lowering breast cancer risk. Fiber helps the body remove excess hormones, carcinogens, and toxic compounds. Fiber is not present in animal products, but is found in virtually all plant foods: whole grains, legumes, vegetables, and fruit.Cade JE, Burley VJ, Greenwood DC. Dietary fibre and risk of breast cancer in the UK Women's Cohort Study. Int J Epidemiology. Advance Access published on January 24, 2007

Cancer-Related Hormones Associated with Protein and Dairy ConsumptionA study recently published in the European Journal of Clinical Nutrition found that elevated insulin-like growth factor-I (IGF-I) levels were positively associated with the consumption of protein (mainly from animal sources), milk, cheese, calcium, magnesium, phosphorous, potassium, and vitamins B2 and B6. The study examined 2,109 women from eight European countries who had been subjects in a previous breast cancer study (the European Prospective Investigation into Cancer and Nutrition). Inverse relationships were found between IGF-I levels and the intake of vegetables and beta-carotene (found in orange-colored fruits and vegetables as well as dark leafy greens). Previous evidence has revealed that elevated IGF-I levels are associated with a variety of cancers, including colorectal, prostate, and premenopausal breast cancer.Norat T, Dossus L, Rinaldi S, et al. Diet, serum insulin-like growth factor-1 and IGF-binding protein-3 in European women. Eur J Clin Nutr. January 2007; 61:91-98.

Broccoli Compound Helps Destroy Breast Cancer CellsNew research suggests that a specific compound in cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, cabbage, kale, etc.) may be especially helpful in inhibiting breast cancer development. Researchers at the University of Leicester looked at the effect of indole-3-carbinol (I3C) on four different types of breast cancer cells. Previous studies have shown that foods rich in indoles may help to kill breast cancer cells by diminishing the expression of the epidermal growth factor receptor, which protects cancer cells. This study found that I3C helped to reduce these receptors in three of the four types of breast cancer cells. Consuming cruciferous vegetables daily may significantly lower breast cancer risk and increase survival.Moiseeva EP, Heukers R, Manson MM. EGFR and Src are involved in indole-3-carbinol-induced death and cell cycle arrest of human breast cancer cells. Carcinogenesis 2007. Feb;28:435-45

Simple Fat Change Radically Improves Mental and Physical HealthA new study adds to the evidence suggesting that the imbalance of fatty acids in the typical American diet could be associated with a sharp increase in heart disease and depression over the course of the last century.The more omega-6 fats people had in their blood compared with omega-3 fats, the more likely they were to suffer from depression, and the more likely they were to have higher blood levels of inflammation-promoting compounds.Inflammation-promoting compounds, such as tumor necrosis factor alpha and interleukin-6, have been linked to heart disease, type 2 diabetes, arthritis and other ailments.Omega-3 fats are found in foods such as fish, flax seed oil and walnuts. Omega-6 fats are found in refined vegetable oils, which in modern times are used in many products ranging from margarine to baked goods to snack foods.The amount of omega-6 fats in the Western diet increased greatly when refined vegetable oils became part of the diet in the early 20th century.Psychosomatic Medicine March 30, 2007Reuters April 17, 2007

Who Would Have Thought This Fat Could Improve Your Bones?A study about the role fatty acids play in building the bone mineral density of young men found that concentrations of omega-3 fats were associated with positive bone mineral densities.Researchers evaluated the bone health (hip, spine and body) and measured the concentrations of fatty acids in 78 teenage men over an eight-year span. In addition to the other benefits, docosahexaenoic acid (DHA) was linked to better total bone densities, particularly in the spine, as well as positive changes in the spine for men between the ages of 16 and 22.American Journal of Clinical Nutrition March 2007; 85(3): 803-807 American Journal of Clinical Nutrition March 2007; 85(3): 647-648

Honey Remedy Could Save LimbsBrandon Keim 10.11.06 | 1:00 AM When Jennifer Eddy first saw an ulcer on the left foot of her patient, an elderly diabetic man, it was pink and quarter-sized. Fourteen months later, drug-resistant bacteria had made it an unrecognizable black mess.

Doctors tried everything they knew -- and failed. After five hospitalizations, four surgeries and regimens of antibiotics, the man had lost two toes. Doctors wanted to remove his entire foot.

"He preferred death to amputation, and everybody agreed he was going to die if he didn't get an amputation," said Eddy, a professor at the University of Wisconsin School of Medicine and Public Health.

With standard techniques exhausted, Eddy turned to a treatment used by ancient Sumerian physicians, touted in the Talmud and praised by Hippocrates: honey. Eddy dressed the wounds in honey-soaked gauze. In just two weeks, her patient's ulcers started to heal. Pink flesh replaced black. A year later, he could walk again.

"I've used honey in a dozen cases since then," said Eddy. "I've yet to have one that didn't improve."

Eddy is one of many doctors to recently rediscover honey as medicine. Abandoned with the advent of antibiotics in the 1940s and subsequently disregarded as folk quackery, a growing set of clinical literature and dozens of glowing anecdotes now recommend it.

Most tantalizingly, honey seems capable of combating the growing scourge of drug-resistant wound infections, including group A streptococcus -- the infamous flesh-eating bug -- and methicillin-resistant Staphylococcus aureus, or MRSA, which in its most severe forms also destroys flesh. These have become alarmingly more common in recent years, with MRSA alone now responsible for half of all skin infections treated in U.S. emergency rooms. So-called superbugs cause thousands of deaths and disfigurements every year, and public health officials are alarmed.

Though the practice is uncommon in the United States, honey is successfully used elsewhere on wounds and burns that are unresponsive to other treatments. Some of the most promising results come from Germany's Bonn University Children's Hospital, where doctors have used honey to treat wounds in 50 children whose normal healing processes were weakened by chemotherapy.

The children, said pediatric oncologist Arne Simon, fared consistently better than those with the usual applications of iodine, antibiotics and silver-coated dressings. The only adverse effects were pain in 2 percent of the children and one incidence of eczema. These risks, he said, compare favorably to iodine's possible thyroid effects and the unknowns of silver -- and honey is also cheaper.

"We're dealing with chronic wounds, and every intervention which heals a chronic wound is cost effective, because most of those patients have medical histories of months or years," he said.

While Eddy bought honey at a supermarket, Simon used Medihoney, one of several varieties made from species of Leptospermum flowers found in New Zealand and Australia.

Honey, formed when bees swallow, digest and regurgitate nectar, contains approximately 600 compounds, depending on the type of flower and bee. Leptospermum honeys are renowned for their efficacy and dominate the commercial market, though scientists aren't totally sure why they work.

"All honey is antibacterial, because the bees add an enzyme that makes hydrogen peroxide," said Peter Molan, director of the Honey Research Unit at the University of Waikato in New Zealand. "But we still haven't managed to identify the active components. All we know is (the honey) works on an extremely broad spectrum."

Attempts in the lab to induce a bacterial resistance to honey have failed, Molan and Simon said. Honey's complex attack, they said, might make adaptation impossible.

Two dozen German hospitals are experimenting with medical honeys, which are also used in the United Kingdom, Australia and New Zealand. In the United States, however, honey as an antibiotic is nearly unknown. American doctors remain skeptical because studies on honey come from abroad and some are imperfectly designed, Molan said.

In a review published this year, Molan collected positive results from more than 20 studies involving 2,000 people. Supported by extensive animal research, he said, the evidence should sway the medical community -- especially when faced by drug-resistant bacteria.

"In some, antibiotics won't work at all," he said. "People are dying from these infections."

Commercial medical honeys are available online in the United States, and one company has applied for Food and Drug Administration approval. In the meantime, more complete clinical research is imminent. The German hospitals are documenting their cases in a database built by Simon's team in Bonn, while Eddy is conducting the first double-blind study.

"The more we keep giving antibiotics, the more we breed these superbugs. Wounds end up being repositories for them," Eddy said. "By eradicating them, honey could do a great job for society and to improve public health."

1 This story was updated to clarify that there are a range of MRSA symptoms, of which the most severe is necroticizing fasciitis. 10.11.06 | 6:01 PM

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"You see, it's not the blood you spill that gets you what you want, it's the blood you share. Your family, your friendships, your community, these are the most valuable things a man can have." Before Dishonor - Hatebreed

Originally posted: May 15, 2007Treadmill desks cut obesity Sitting is an occupational hazard for office workers, but there’s a new way to avoid it: a vertical work station that incorporates a treadmill at a desk.

These “walk-and-work” office desks could help obese employees lose weight, according to a small study published in the British Journal of Sports Medicine.

The participants were able to use the computer while walking without falling or injuring themselves. In fact, they enjoyed it so much, they wanted to keep the walking desks even after the study ended.

The idea builds on the notion that we all need high levels of spontaneous activity throughout the day, also called non-exercise activity thermogenesis (NEAT).

Obese people generally have low levels of NEAT. Lean people have high levels.

But does the desk treadmill really work? I checked with Nat Findlay, 52, who built a custom vertical workstation for $10,000, including $1,500 for the treadmill. (They're not all this expensive. The workstation described in the study can be purchased for about $1,000)

“I was a classic guy on conference calls all day,” said Findlay, whose voice doesn’t betray the fact that his treadmill begins moving at less than a mile an hour when he picks up the phone.

“I’d sit in my chair all day and have no energy. I thought, ‘this is nuts. I’m making a nice salary but the rest of me is going to hell by just sitting there.”

Findlay got the idea from Mayo Clinic researcher James Levin, a co-author of the BJSM study who has been touting the benefits of his walking desk for years.

“At the end of the day, this is what we should be doing,” said Findlay, the vice president of Canadian operations for Cardinal Health, a healthcare company. “We’ve degenerated into the corporate world. Instead of spending millions of dollars in health care for employees, buy them a treadmill for their desk.”

I’m ready to trade my exercise ball chair for a desk treadmill. Hello, Chicago Tribune? Will you spring for one?

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"You see, it's not the blood you spill that gets you what you want, it's the blood you share. Your family, your friendships, your community, these are the most valuable things a man can have." Before Dishonor - Hatebreed

Contact: Liz Savagejncimedia@oxfordjournals.org301-841-1287Journal of the National Cancer InstituteHeavy multivitamin use may be linked to advanced prostate cancer

The embargo has been lifted at the request of the submitting PIO.

While regular multivitamin use is not linked with early or localized prostate cancer, taking too many multivitamins may be associated with an increased risk for advanced or fatal prostate cancers, according to a study in the May 16 issue of the Journal of the National Cancer Institute.

Millions of Americans take multivitamins because of a belief in their potential health benefits, even though there is limited scientific evidence that they prevent chronic disease. Researchers have wondered what impact multivitamin use might have on cancer risk.

Karla Lawson, Ph.D., of the National Cancer Institute in Bethesda, Md., and colleagues followed 295,344 men enrolled in the National Institutes of Health-AARP Diet and Health Study to determine the association between multivitamin use and prostate cancer risk. After five years of follow-up, 10,241 men were diagnosed with prostate cancer, including 8,765 with localized cancers and 1,476 with advanced cancers.

The researchers found no association between multivitamin use and the risk of localized prostate cancer. But they did find an increased risk of advanced and fatal prostate cancer among men who used multivitamins more than seven times a week, compared with men who did not use multivitamins. The association was strongest in men with a family history of prostate cancer and men who also took selenium, beta-carotene, or zinc supplements.

“Because multivitamin supplements consist of a combination of several vitamins and men using high levels of multivitamins were also more likely to take a variety of individual supplements, we were unable to identify or quantify individual components responsible for the associations that we observed,” the authors write.

In an accompanying editorial, Goran Bjelakovic, M.D., of the University of Nis in Serbia, and Christian Gluud, M.D., of Copenhagen University Hospital in Denmark, discuss the positive and negative health effects of antioxidant supplements. “Lawson [and colleagues] add to the growing evidence that questions the beneficial value of antioxidant vitamin pills in generally well-nourished populations and underscore the possibility that antioxidant supplements could have unintended consequences for our health,” the authors write.###

Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage. Visit the Journal online at http://jnci.oxfordjournals.org/.

I get a kick about "mulling" the idea around to have on a child's report card that they are overweight (parents certainly need this).

Or the part with the nutritionist who thinks the idea is "commendable" (they always do).

Why don't they simply outlaw high caloric food? They could shutdown half the businesses in NJ. Instead of a pizza parlor on every corner for thousands of square miles we could have salad bars on every corner. Or tax each calorie served by one cent. Democrat Gov. Corzine must love that idea.

CCP, Strange story. In my narrow mind it would be the parents asking the school to watch what the kids are eating while under their watch. The parent-child-public school relationship keeps getting twisted. Now the school (or village) raises the child and the parents play a limited role. (?) My current perspective comes from sex ed taught in coed classes to 6th grade. They send my daughter (now 7th grade) home with family discussion questions to fill out, where I might think the teaching should come from the family and the questions go to the school to make sure they aren't undermine what we teach.

Your comment on the NJ Gov. is funny. I saw him advocate seatbelt use on a national commercial last night. Choosing more salad and less pizza is nice if it is market driven, and Orwellian if mandated. Maybe we can have surveillance cameras over the salt shakers - ok, this isn't very funny.

The role of the 'state' in obesity is inevitable if we accept the idea that the state is responsible for our health care. It was supposed to be a joke that after tobacco the government would go after fast food...

Back to the science, please expand on your idea that the answer to obesity will come from medicine when you get a chance.

I'm not against serving nutritional, healthy food in schools where the environment is controlled, per se.

But this is clearly the proverbial slippery slope. Isn't Clinton involved in obesity causes and the Hill of course wants to revamp all of health care. Well we can see where this is all heading.

Our desire to eat and eat well has backfired from an evolutionary point of view. When we were hunters and gatherers or farmers we expended trememdous amounts of energy to secure food. We needed tremendous internal controls that would drive us to seek food in order to survive. We didn't have lots of good tasting fatty and sugary foods simply lying around for the picking. We burned more calories and ingested less. Now those days are gone. Yet we still have the internal controls that drive us to eat. We really do not understand these controls very well at all. Years ago I read there were over 30 genes associated with being overweight. There must be more now. an endocrine friend researcher told me that all the studies he participated in appear to show that any one particular drug will cause ~ 7% weight loss before other metabolic factors begin to overcome this preventing further weight gain. "It's amazing, that 7% number keeps coming up," he says.

It is well known but rarely for whatever reason admitted in health care that getting people to lose weight and keep it off is extraordinarily difficult. The only effective means we have that often will work in the long term is bariatric surgery. Yet we all know how drastic this is and always with its own risks.

Until we have a better understanding on energy metabolism and weight metabolism all other methods are doomed to fail. Sure, low carb diets may work for a few, exercise will work for a few, but for every success story on long term weight loss and maitenance there are 19 that end in failure.

All these politicians with their political grandstanding. It drives me to eat! If they want to raise money for research or grants for the NIH or other university sponsored research than fine. Pharmaceutical research is done in private. There must be a lot of duplication going on. Data is not shared. We really don't need separate governmental "agencies" for this.

And *what about* all the abundance of fattening foods? You simply can't eat pizza and lose weight. (well maybe one slice) Will people have to show IDs at pizza parlors, Chinese restaurants, Jewish delis, and Dunkin Donuts?

We have all seen the news about the lawyer who flew around with this. What I have not seen is any conjecture as to where *he* picked up the bug. I find the furor over his travelling with it of no less a concern than the question of how he aquired it..

Two centuries of success against infectious disease have left us complacent—and vulnerable.

There have been at work among us three great social agencies: the London City Mission; the novels of Mr. Dickens; the cholera.” Historian Gertrude Himmelfarb quotes this reductionist observation at the end of her chapter on Charles Dickens in The Moral Imagination; her debt is to an English nonconformist minister, addressing his flock in 1853. It comes as no surprise to find the author of Hard Times and Oliver Twist discussed alongside Edmund Burke and John Stuart Mill in a book on moral history. Nor is it puzzling to see Dickens honored in his own day alongside the City Mission, a movement founded to engage churches in aiding the poor. But what’s V. cholerae doing up there on the dais beside the Inimitable Boz? It’s being commended for the tens of millions of lives it’s going to save. The nastiness of this vile little bacterium has just transformed ancient sanitary rituals and taboos into a new science of epidemiology. And that science is about to launch a massive—and ultimately successful—public effort to rid the city of infectious disease.

The year 1853, when a Victorian doctor worked out that cholera spread through London’s water supply, was the turning point. Ordinary people would spend the next century crowding into the cities, bearing many children, and thus incubating and spreading infectious disease. Public authorities would do all they could to wipe it out. For the rest of the nineteenth century, they lost more ground than they gained, and microbes thrived as never before. Then the germ killers caught up—and pulled ahead. When Jonas Salk announced his polio vaccine to the press in April 1955, the war seemed all but over. “The time has come to close the book on infectious disease,” declared William Stewart, the U.S. surgeon general, a few years later. “We have basically wiped out infection in the United States.”

By then, however, infectious diseases had completed their social mission. Public authorities had taken over the germ-killing side of medicine completely. The focus shifted from germs to money—from social disease to social economics. As germs grew less dangerous, people gradually lost interest in them, and ended up fearing germ-killing medicines more than the germs themselves.

Government policies expressed that fear, putting the development, composition, performance, manufacture, price, and marketing of antibiotics and vaccines under closer scrutiny and control than any public utility’s operations and services. The manufacturers of these drugs, which took up the germ-killing mission where the sewer commission left off, must today operate like big defense contractors, mirror images of the insurers, regulatory agencies, and tort-litigation machines that they answer to. Most drug companies aren’t developing any vaccines or antibiotics any more. The industry’s critics discern no good reason for this at all: as they tell it, the big drug companies just can’t be bothered.

These problems capture our attention only now and again; they hardly figure in the much louder debate about how much we spend on doctors and drugs, and who should pay the bills. “Public health” (in the literal sense) now seems to be one thing, and—occasional lurid headlines notwithstanding—not a particularly important one, while “health care” is quite another.

We will bitterly regret this shift, and probably sooner rather than later. As another Victorian might have predicted—he published a book on the subject in 1859—germs have evolved to exploit our new weakness. Public authorities are ponderous and slow; the new germs are nimble and fast. Drug regulators are paralyzed by the knowledge that error is politically lethal; the new germs make genetic error—constant mutation—the key to their survival. The new germs don’t have to be smarter than our scientists, just faster than our lawyers. The demise of cholera, one could say, has been one of the great antisocial developments of modern times.

By withdrawing from the battlefield just long enough to let us drift into this state of indifference, the germs have set the stage for their own spectacular revival. Germs are never in fact defeated completely. If they retire for a while, it’s only to search, in their ingeniously stupid and methodically random way, for a bold new strategy. They’ve also contrived, of late, to get human sociopaths to add thought and order to the search. The germs will return. We won’t be ready.

"You see, it's not the blood you spill that gets you what you want, it's the blood you share. Your family, your friendships, your community, these are the most valuable things a man can have." Before Dishonor - Hatebreed

By NICHOLAS WADEPublished: June 7, 2007In a surprising advance that could sidestep the ethical debates surrounding stem cell biology, researchers have come much closer to a major goal of regenerative medicine, the conversion of a patient’s cells into specialized tissues that might replace those lost to disease.

Skip to next paragraph MultimediaGraphic From Skin Cells to Stem Cells RelatedA Long, Uncertain Path for New Cell Technique (June 7, 2007) Times Topics: Stem CellsThe advance is an easy-to-use technique for reprogramming a skin cell of a mouse back to the embryonic state. Embryonic cells can be induced in the laboratory to develop into many of the body’s major tissues.

If the technique can be adapted to human cells, researchers could use a patient’s skin cells to generate new heart, liver or kidney cells that might be transplantable and would not be rejected by the patient’s immune system. But scientists say they cannot predict when they can overcome the considerable problems in adapting the method to human cells.

Previously, the only way to convert adult cells to embryonic form has been by nuclear transfer, the insertion of an adult cell’s nucleus into an egg whose own nucleus has been removed. The egg somehow reprograms the nucleus back to an embryonic state. That procedure is known as therapeutic cloning when applied to people, but no one has yet succeeded in doing it.

The new technique, developed by Shinya Yamanaka of Kyoto University, depends on inserting just four genes into a skin cell. These accomplish the same reprogramming task as the egg does, or at least one that seems very similar.

The technique, if adaptable to human cells, is much easier to apply than nuclear transfer, would not involve the expensive and controversial use of human eggs, and should avoid all or almost all of the ethical criticism directed at the use of embryonic stem cells.

“From the point of view of moving biomedicine and regenerative medicine faster, this is about as big a deal as you could imagine,” said Irving Weissman, a leading stem cell biologist at Stanford University, who was not involved in the new research.

David Scadden, a stem cell biologist at the Harvard Medical School, said the finding that cells could be reprogrammed with simple biochemical techniques “is truly extraordinary and frankly something most assumed would take a decade to work out.”

The technique seems likely to be welcomed by many who have opposed human embryonic stem cell research. It “raises no serious moral problem, because it creates embryoniclike stem cells without creating, harming or destroying human lives at any stage,” said Richard Doerflinger, the United States Conference of Catholic Bishops’ spokesman on stem cell issues. In themselves, embryonic stem cells “have no moral status,” and the bishops’ objections to embryonic stem cell research rest solely on the fact that human embryos must be harmed or destroyed to obtain them, Mr. Doerflinger said.

Ronald Green, an ethicist at Dartmouth College, said it would be “very hard for people to say that what is created here is a nascent form of human life that should be protected.” The new technique, if adaptable to human cells, “will be one way this debate could end,” Mr. Green said.

Biologists learned how to generate human embryonic stem cells in 1998 from the few-day-old embryos discarded by fertility clinics, a procedure the embryos did not survive. This source proved controversial, and biologists supported by federal financing were unable to explore the new opportunity until August 2001 when President Bush, in a political compromise, decreed that research on human embryonic stem cells could begin, but only with cell lines already in existence by that date.

The restrictions have caused considerable frustration among biologists and other supporters of research on embryonic stem cells. Indeed, the House is expected to vote today to increase federal funds for such research. If approved, the bill, similar to one approved by the Senate, would go to the president. The White House has already said that the president will veto it.

The new technique, when adaptable to human cells, should sidestep all these problems. James Battey, vice chairman of the National Institutes of Health stem cell task force, said he saw “no impediment at all” to federal support of researchers using the new technique on human cells.

Ever since the creation of Dolly the sheep, the first cloned mammal, scientists have sought to lay hands on the mysterious chemicals with which an egg will reprogram a mature cell nucleus injected into it and set the cell on the same path of embryonic development as when egg and sperm combine.

Years of patient research have identified many of the genes that are active in the embryonic cell and maintain its pluripotency, or ability to morph into many different tissues. Last year, Dr. Yamanaka and his colleague Kazutoshi Takahashi, both at Kyoto University, published a remarkable report relating how they had guessed at 24 genes responsible for maintaining pluripotency in mouse embryonic stem cells.

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When they inserted all 24 genes into mouse skin cells, some of the cells showed signs of pluripotency. The Kyoto team then subtracted genes one by one until they had a set of four genes that were essential. The genes are inserted into viruses that infect the cell and become active as the virus replicates. The skin cell’s own copies of these genes are repressed since they would interfere with its function. “We were very surprised” that just four genes are sufficient to reprogram the skin cells, Dr. Yamanaka said.

Stem CellsDr. Yamanaka’s report riveted the attention of biologists elsewhere. Two teams set out to repeat and extend his findings, one led by Rudolf Jaenisch of the Whitehead Institute and the other by Kathrin Plath of the University of California, Los Angeles, and Konrad Hochedlinger of Massachusetts General Hospital. Dr. Yamanaka, too, set about refining his work.

In articles published today in Nature and a new journal, Cell-Stem Cell, the three teams show that injection of the four genes identified by Dr. Yamanaka can make mouse cells revert to cells indistinguishable from embryonic stem cells. Dr. Yamanaka’s report of last year showed that only some properties of embryonic stem cells were attained.

This clear confirmation of Dr. Yamanaka’s recipe is exciting to researchers because it throws open to study the key process of multicellular organisms, that of committing cells to a variety of different roles, even though all carry the same genetic information.

Recent studies have shown that the chromatin, the complex protein material that clads the DNA in chromosomes, is not passive packaging material but highly dynamic. It contains systems of switches that close down large suites of genes but allow others to be active, depending on the role each cell is assigned to perform.

Dr. Yamanaka’s four genes evidently reset the switch settings appropriate for a skin cell to ones that specify an embryonic stem cell. The technique is easy to use and “should revolutionize the field since every small lab can work on reprogramming,” said Alexander Meissner, a co-author of Dr. Jaenisch’s report.

An immediate issue is whether the technique can be reinvented for human cells. One problem is that the mice have to be interbred, which cannot be done with people. Another is that the cells must be infected with the gene-carrying virus, which is not ideal for cells to be used in therapy. A third issue is that two of the genes in the recipe can cause cancer. Indeed 20 percent of Dr. Yamanaka’s mice died of the disease. Nonetheless, several biologists expressed confidence that all these difficulties would be sidestepped somehow.

“The technical problems seem approachable — I don’t see anyone running into a brick wall,” said Owen Witte, a stem cell biologist at U.C.L.A. Dr. Jaenisch, in a Webcast about the research, predicted that the problems of adapting the technique to human cells would be solvable but he did not know when.

If a human version of Dr. Yamanaka’s recipe is developed, one important research use, Dr. Weissman said, will be to reprogram diseased cells from patients so as to study the molecular basis of how their disease develops.

Beyond that is the hope of generating cells for therapy. Researchers have learned how to make embryonic cells in the laboratory develop into neurons, heart muscle cells and other tissues. In principle, these might be injected into a patient to replace or supplement the cells of the diseased tissue, without fear of immune rejection.

No one really knows if the new cells would succumb to the same disease process, or if they would be well behaved, given that they developed in a laboratory dish without recapitulating the exact succession of environments they would have experienced in the embryo.

Still, repairing the body with its own cells should in principle be a superior to the surgeon’s knife and the oncologists’ poisons. Cloning Bill Defeated in House

WASHINGTON, June 6 (AP) — House Republicans united Wednesday to reject a bill supported by Democrats that would make it illegal to use cloning technology to initiate a pregnancy and create a cloned human being. The parties accused each other of using the legislation to score political points before the House votes Thursday on a stem cell bill that President Bush says he will veto.

MEDICAL EXAMINER: SPORTS CREAM CAUSES TEEN'S DEATH: A medical examiner blamed a 17-year-old track star's death on the use of too much muscle cream, the kind used to soothe aching legs after exercise. Arielle Newman, a cross-country runner at Notre Dame Academy on Staten Island, died after her body absorbed high levels of methyl salicylate, an anti-inflammatory found in sports creams such as Bengay and Icy Hot, the New York City medical examiner said Friday.

IMO this is totally crazy. Anyone near enough can pick up RF. Why not implant a listening device or GPS device? I don't think anyone really understands what we are getting into. As a person who has been stalked by organized crime people this to me is just plain nuts. Why can't the person carry a small disc on their person rather than inside their body? I am totally against this. I don't know which doctors think this is a good idea but they IMO are darn fools.